Clinical Competency Name: Post-operative use of Metaraminol in Recovery

Transcription

1 Clinical Competency Name: Post-operative use of Metaraminol in Recovery Trainee name: Title: Ward or department: Method of assessment: Clinical assessor: Name: Title: Professional assessor: Name: Title:

2 Clinical Competency Name: Post-operative use of Metaraminol in Recovery Name: Ward: Date: Method of assessment: Question, observation and case scenario s No errors observed 5 Occasional errors, corrected by trainee 4 Frequent errors, corrected by trainee 3 Frequent errors, not corrected by trainee 2 Trainee unable to proceed without step-by-step instruction/prompting 1 = knowledge S= skill Observable criteria S/ Circle assessment outcome Outcome Pass X Fail X Assessors Signature and Date 1. State the clinical indications for administering Metaraminol 2. Discuss the desired therapeutic effects of this drug 3. State 4 clinical contra-indications to administering Metaraminol 4. Discuss at least 4 examples of medical conditions in which Metaraminol should be used with caution 5. Describe the speed of onset and duration of action of the drug 6. State at least 6 non-desirable effects of this drug 7. Discuss at least 4 safety aspects EVT competency MF/Nov2010 2

3 that should be considered when administering Metaraminol and how you would manage them 8. Explain how you would draw up the drug (i.e. dose, diluent and volume) and how much you would administer 9. Demonstrate the ability to conduct and interpret a cardiovascular assessment 10. Discuss how you would recognise an adverse effect to Metaraminol and what action you would take 11. Explain how you would change a Metaraminol infusion S S EVT competency MF/Nov2010 3

4 Learning log To be completed by the assessor when all the sections above have been signed confirming that the above named person has been assessed as competent. Assessment outcome: Pass Refer Assessed by: Name: Grade: Date: Please place one copy in your professional portfolio and give a second copy to the ward leader. EVT competency MF/Nov2010 4

5 Competency Name: Assessors Guidelines Observable criteria nowledge 1. State the clinical indications for administering The use of Metaraminol is sometimes used as an emergency method of Metaraminol raising blood pressure where other measures have failed. Metaraminol is a sympathomimetic, adrenoceptor stimulant. It directly and indirectly stimulates the alpha receptors in the sympathetic nervous sytem. Alpha stimulation causes vasoconstriction with an increase in both systolic and diastolic blood pressure and an increase in systemic vascular resistance. The force of the heart's pumping action is increased and peripheral blood vessels constrict. 2. Discuss the desired therapeutic effects of this drug To increase blood pressure to a level that enables adequate organ 3. State 4 clinical contra-indications to administering Metaraminol perfusion, whilst limiting the non-dersirable side effects. Hypovolaemia: the underlying fluid depletion must be corrected first Hypersensitivity Patients taking monoamineoxidase inhibitors (MAOIs), or within 14 days of such treatment Pregnancy 4. Discuss at least 4 examples of medical conditions in which Metaraminol should be used with caution and explain why Renal impairment: Renal vasoconstriction may reduce blood flow to the kidneys and lead to further impairment. Elderly: increased risk of arrythmias Uncorrected hypovolaemia: circulating volume should be optimised prior to commencing vasopressors Hypoxia or hypercapnia Following myocardial infarction: can cause arrythmias and tachycardias Diabetes mellitus: due to vasoconstriction effect Presence of coronory, mesenteric or peripheral thrombosis Hyperthyroidism: due to vasoconstriction effect EVT competency MF/Nov2010 5

6 Liver cirrhosis: metaraminol is metabolised in the liver. Asthma: risk of allergy to sulfides Patients receiving Mono Amine Oxidase Inhibitors or tricyclic antidepressants: action of metaraminol may be potentiated. Start with a low dose. Malaria: may provoke a relapse 5. Describe the speed of onset and duration of action of Its effects commence 1 to 2 minutes after intravenous (IV) injection and the drug lasts 20 minutes to 1 hour in the absence of??? 6. State at least 6 non-desirable effects of this drug Hypoxia, nausea & vomiting, arrhythmias, peripheral ischaemia, palpitation, hypertension, bradycardia, tachycardia, dyspnoea, headache, confusion, anxiety, psychosis, tremor, urinary retention, 7. Discuss at least 4 safety aspects that should be considered when administering Metaraminol and how you would manage them 8. Explain how you would draw up the drug (i.e. dose, diluent and volume) and how much you would administer (as a bolus dose and as an infusion) The intravenous cannula must be checked for patency as extravasation at the injection site may cause necrosis. Due to the potent cardiovascular effects of the drug continuous cardiac monitoring should be in place, and the ability to monitor bloodpressure at least every 5 minutes. Resuscitation equipment must be available. Metaraminol has an excessive vasopressor response and may cause a prolonged rise in blood pressure even when therapy is discontinued. Patients should be kept under close observation, until the effects of the drug have fully worn off. Effects of concommittant opioids: opioids can cause hypotension Renal vasoconstriction: document hourly urine volumes. Aim for > 0.5ml/kg/hr. Rapid hypertension: this may give rise to pulmonary oedema, cardiac arrhythmias and cardiac arrest. Bolus dose: Dilute 10mg metaraminol with 20ml sterile 0.9% normal saline, to give a concentration of 0.5mg/ml. Administer 0.5-1ml slowly and assess blood pressure. If no response after 2-3 minutes, administer a further 1mg and assess blood pressure. Additional doses may be given up to 5 mg. EVT competency MF/Nov2010 6

7 Flush with 0.9% normal saline. Infusion: Dilute 20mg in 40ml. Infuse via a syringe driver. Start at 4mls/hr and titrate up or down according to BP response. 9. Demonstrate the ability to conduct and interpret a cardiovascular assessment 10. Discuss how you would recognise an adverse effect to Anaphylaxis: Metaraminol and what action you would take 11. Explain how you would change a metaraminol infusion Do not allow the infusion syringe to run out before having the next one ready. As soon as the pump notifies you that the infusion is near its end, replace with a new infusion syringe. Monitor the BP closely. If it falls, increase the infusion rate by 1 increment until the BP stabilises. Then decrease the infusion to its original rate. EVT competency MF/Nov2010 7