patient group direction

Transcription

1 PRESERVATIVE-FREE LIDOCAINE v1.0 1/9 PRESERVATIVE-FREE LIDOCAINE PGD Details Version 1.0 Legal category Staff grades Approved by POM Registered Paramedic Registered Nurse Medicines Management Group Date issued 01/02/2015 Review date 31/01/2017 Clinical Publication Category MANDATORY - No deviation from document permissible Clinical Requirements Competencies Continuing education Successful completion of a competency assessment in the use of this medicine for the indications stated. Completion of education in both the legal and professional aspects of PGD administration and the supply of medicines. The clinician is responsible for keeping him/herself aware of any changes to the recommendations for the medicine listed. It is the responsibility of the individual to keep upto-date with continued professional development and to work within the limitations of their own individual scope of practice.

2 PRESERVATIVE-FREE LIDOCAINE v1.0 2/9 Clinical Situation Clinical situation Inclusion criteria Exclusion criteria Cautions Local analgesia to reduce the discomfort experienced when: an IO is flushed infusions or drugs are administered IO Adult and paediatric patients who meet the criteria for IO administration: Actual or potentially life threatening presentation; intravenous fluids or medications are required; peripheral IV access cannot be established in 2 attempts or 90 seconds Patient is conscious and sensitive to pain. Known hypersensitivity to lidocaine Patients who do not meet all the following criteria required for IO administration: Actual or potentially life threatening presentation; intravenous fluids or medications are required; peripheral IV access cannot be established in 2 attempts or 90 seconds Unconscious patients Inflamed or infected tissue at the insertion site All grades of AV heart block Acute porphyria Pregnancy (crosses placenta) Not for intravenous injection. Observe for extravasation Use with caution in patients with epilepsy, respiratory impairment, impaired cardiac conduction, bradycardia, severe shock (hypovolaemia), myasthenia gravis. Sino-atrial disorders Hepatic impairment increased risk of side-effects as 80% metabolised in liver. Renal impairment

3 PRESERVATIVE-FREE LIDOCAINE v1.0 3/9 Fluids tend to flow easier through the humerus than the tibia, requiring less pressure to deliver the initial flush. Less pressure results in less pain. A single use of lidocaine does not generally cause systemic side-effects. Allergic reactions (rash, swelling, breathlessness and low blood pressure) possible. Side effects Action if excluded Action if patient declines Symptoms of overdose Effects initially include a feeling of inebriation and lightheadedness followed by sedation, peri-oral paraesthesia (tingling of skin around mouth), numbness of tongue, abnormal taste, blurred vision, ringing in the ears and twitching. In serious cases of overdose fits, low blood pressure, respiratory depression and bradycardia can be lifethreatening. Convulsions can occur in severe reactions. The risk of side effects are minimised by slow administration, this also ensures the Lidocaine remains within the cavity for maximum effect. If patient meets exclusion criteria: Explain reason to patient/carer. Refer to a medical practitioner if appropriate Document reason and any action taken in patient clinical record (PCR). If patient declines treatment or advice ensure the patient clinical record details: The advice given by the clinician Details of any referral made The intended actions of the patient (including parent or guardian).

4 PRESERVATIVE-FREE LIDOCAINE v1.0 4/9 Description of Treatment Generic name Presentation Route Method Lidocaine (preservative-free) Injection 1% (10mg in 1ml) 5ml ampoule Intraosseous (IO) administration only NOT FOR INTRAVENOUS USE Administration Supply Monitor patient s obs/ecg during IO administration. Administer initial (higher) dose of IO Lidocaine over 1-2 minutes directly into IO needle. Observe for extravasation, hypersensitivity and other side effects Allow Lidocaine to dwell in IO space for 60 secs approx. Flush the IO needle with 5-10mls (adults) 2-5mls (infants & children) sodium chloride over 5 seconds. Administer subsequent (lower) dose of IO Lidocaine over 30 seconds. Inject or infuse fluid or medications under pressure as required Continue to monitor patient. 0.5mg/kg Age Weight (KG) Volume of 1% (ml) preservative-free lidocaine Initial (Higher) Subsequent (Lower) Neonate Dose Neonate weeks months months months year months

5 PRESERVATIVE-FREE LIDOCAINE v1.0 5/9 2 years years years years years years years years years years years years years years years Adult Dose calculation : Volume in ml of 1% Lidocaine = 0.5 x weight (kg) 10 Frequency Duration of treatment Subsequent (lower) dose may be repeated every 45 minutes if fluids are infused and discomfort recurs. Single episode of care

6 PRESERVATIVE-FREE LIDOCAINE v1.0 6/9 Follow Up Referral arrangements and safety netting Advice to patients Records References Ensure that the receiving hospital staff are aware that an IO has been placed and that IO Lidocaine has been used. This should be clearly recorded within the medicines section of the patient clinical record. Explain treatment and course of action All patients must be admitted to hospital Complete patient clinical record. British National Formulary 68 September 2014 to March 2015 Emerg Med J May;30(5): doi: / emermed Towards evidence-based emergency medicine: Best BETs from the Manchester Royal Infirmary. BET 1: Local anaesthetics in intraosseous access. Hixson R.2011 IO Analgesia: a suggested protocol. Philbeck T, E., Miller, L, J., Montez, D., Puga, T. (2010) Hurts so good; easing IO pain and pressure: JEMS; 35(9) 58-69

7 PRESERVATIVE-FREE LIDOCAINE v1.0 7/9 Authorisation Chief Executive Officer Ken Wenman Signature Date 30/01/2015 Medical Director Dr Andy Smith Signature Date 30/01/2015 Pharmaceutical Advisor Sue Oakley Signature Date 30/01/2015 This must be signed by the Chief Executive Officer, Medical Director and Pharmaceutical Advisor to be legally valid.

8 PRESERVATIVE-FREE LIDOCAINE v1.0 8/9 Individual Authorisation (Staff Copy) Individual Signature Date / / Authorising officer Signature Date / / I have read and understood the Patient Group Direction and agree to administer this medicine only in accordance with this document. PGDs do not remove inherent professional obligations or accountability. It is the responsibility of each professional to practice only within the bounds of their own competence and in accordance with their own Code of Professional Conduct. This signed page must be retained by the member of staff, together with the full PGD, which must be available in clinical practice.

9 PRESERVATIVE-FREE LIDOCAINE v1.0 9/9 Individual Authorisation (Trust Copy) Individual Signature Date / / Authorising officer Signature Date / / I have read and understood the Patient Group Direction and agree to administer this medicine only in accordance with this document. PGDs do not remove inherent professional obligations or accountability. It is the responsibility of each professional to practice only within the bounds of their own competence and in accordance with their own Code of Professional Conduct. This signed page must be returned to the Divisional Training Administrator who will update the Electronic Staff Record. This copy must be retained by the Trust Training Department.