Policy Name: Treatment of Anaphylactic Reaction In the Cath Lab Original Date: West Penn Allegheny Health System Forbes Regional Hospital Policy No. 16553 Page 1 of 6 Reviewed by : Mark Taylor, MD, Michael Namisnak, Michele Flatt, Nikki Verkleeren, Rhonda Kempa Date of Last Review: 04/04/2012 Date of Last Revision: Approved by: Lynne Struble Document Owner: Dan Oslowski Revision #: 1 Type of Policy: General: Section Infection Control Safety Department: I. POLICY STATEMENT Anaphylactoid reactions to offending agents will be treated according to the severity of the reaction with the guidance of pre-established protocol, under the direction of the performing physician. II. POLICY PURPOSE To ensure early recognition and treatment of anaphylaxis due to offending agent. III. IV. POLICY DEFINITIONS (if appropriate) RRT: Rapid Response Team ACLS: Advanced Cardiac Life Support BLS: Basic Life Support POLICY GUIDELINES 1. Cardiac s and Radiology Technologists will be certified in ACLS and BLS for healthcare providers. 2. In the event of an unstable or rapidly deteriorating patient the RN/RT can request the rapid response team to assist in the assessment and stabilization of the patient. 3. It will be routine to keep a patient exhibiting any type of allergic reaction to offending agent for approximately one hour or as directed by performing physician. 4. Early recognition of an offending agent reaction is critical. Basic treatment includes: a. Maintain patent IV line. b. Evaluate a pulse rate. c. Administer oxygen to maintain sat > 90% 5. This policy and drug dosing is for the ADULT patient. V. PROCEDURES 1. The RN/RT shall stay with the patient during the anaphylactic reaction.
HIVES 2. IV access shall be maintained. 3. If symptoms occur reassure the patient and notify the RN and cardiologist immediately if not already present. Call RRT or code Blue if necessary. 4. Treatment of specific reaction will be according to protocol and may be modified to each individual. REACTIONS & RESPONSE - 1. Assess vital signs, respiratory status and examine patient s face, neck, and trunk to assess degree of reaction. 2. Reassure patient. Cold wet washcloth / ice pack to area PRN. 1. Diphenhydramine IV 25 to 50 mg IV. DIFFUSE ERYTHEMA / ANGIOEDEMA - 1. Assess vital signs and respiratory status. Place on pulse oximeter, cardiac monitor, and automatic BP Cuff. Record vitals q 5 min. 2. Consider placing patient recumbent and feet elevated if hypotensive. 3. Increase IV fluids using normal saline solution. If patient is hypotensive 4. Appropriate documentation on the medical record is required. 5. Patients should be cautioned about driving or operating heavy equipment after antihistamines. Antihistamines may exacerbate hypotension. 6. Reassure patient. - 1. Epinephrine Sub-Q (1:1000) 0.1-0.2 ml (0.1mg 0.2 mg) (consider any cardiac contraindications) 2. Diphenhydramine 50 mg IV. 3. Famotidine 20mg IV. LARYNGEAL EDEMA Mild symptoms (hoarseness, normal blood pressure, minimal distress) monitor and automatic BP cuff. Document vitals q 5 min. 2. Elevate Head of Bed. 3. Oxygen by nasal cannula 1-2 L/M to bring Sat > 90%. 4. Maintain IV fluids using normal saline solution, at KVO rate.
1. Epinephrine (1:1000) 0.1-0.2 ml Sub-Q (0.1mg 0.2mg) (consider any cardiac contraindications). 2. Page respiratory STAT for cool mist treatment. Severe symptoms (significant respiratory difficulty) 1. Page Respiratory therapist STAT for ABG and further medication orders by. 2. Call Rapid Response Team or CODE BLUE if indicated. Severe symptoms 1. Epinephrine (1:10,000) 1ml (0.1mg) IV slowly. Repeat as necessary. 2. Hydrocortisone Sodium Succinate 500 mg -1000 mg IV slowly over several minutes. 3. Consider intubation. BRONCHOSPASM(expiratory wheezing) Cardiology Nurse monitor and automatic BP cuff. Document vitals q 5 min. 2. Elevate Head of Bed. 3. Oxygen by nasal cannula at 1-2 L/M to bring Sat > 90%. 4. Page Respiratory therapist STAT for ABG and further medication orders by. 5. Call CODE BLUE and initiate CPR if indicated. Mild symptoms 1. Obtain a metered dose inhaler: Albuterol, 1 to 2 puffs. (from pharmacy) 2. Notify respiratory therapist if necessary for Nebulizer Albuterol 0.5% solution, 0.5 ml in 3 ml of normal saline, breathe through nebulizer tube for 8-10 min. Moderate symptoms 1. Nebulizer (see above) Or Epinephrine (1:1000) 0.1-0.2 ml (0.1-0.2 mg) Sub-Q, consider any cardiac contraindications. 2. ABG if indicated. Severe symptoms 1. Epinephrine (1:10,000), 1 ml (0.1mg) IV slowly, repeat as necessary. 2. Call Rapid Response Team or Code BLUE if indicated. PULMONARY EDEMA (very anxious, very short of breath) -
monitor, and automatic BP cuff. Record vitals q 5 min. 2. Elevate head of bed. 3. Oxygen by non-rebreather mask at 10-15 L/M (whatever keeps reservoir bag inflated).maintain sats >90%. 4. Page Respiratory for stat ABG. 5. Reassure patient. 6. Maintain IV fluids, NSS at KVO Rate. 7. Call Rapid Response Team or Code BLUE if indicated. 1. Furosemide 40 mg IV slowly (over minimum of one minute) 2. Morphine 1-3 mg IV slowly. Dilute to one mg/ml and rate is one mg/min. May repeat in q 5-10 min. Have Nalaxone available. 3. Hydrocortisone Sodium Succinate 500mg 1000 mg IV slowly. SYMPTOM- HYPOTENSION WITH BRADYCARDIA - Mild symptoms monitor, and automatic BP cuff. Record vitals q 5 min. 2. Increase IV fluids using normal saline solution wide open. 3. Reassure patient. 4. Oxygen by nasal cannula 1-2 L/M. Maintain sats > 90%. If symptoms progress, page Respiratory and order STAT ABG. - Severe symptoms 1. Oxygen as indicated by ABG. 2. If heart rate is less than 50 with a SIGNIFICANT drop in blood pressure, change in mental status or frequent PVC s, give Atropine 0.5mg IV push. 3. Call Rapid Response Team or Code BLUE if indicated. 4. Atropine may be repeated every 5 minutes x 3 doses, not to exceed a total dose of 2mg. 5. Apply external temporary pacing electrodes and prepare for the need for pacing. 6. If heart rate does not increase, turn on external pacemaker, increasing MA until capture and systolic blood pressure of 100. 7. Consider transvenous pacer insertion. 8. If ineffective, begin Dopamine infusion at 5 mcg/kg/min. 9. Transfer patient to Critical Care, as determined by physician. HYPOTENSION WITH TACHYCARDIA (Very serious = peripheral vasodilation and vascular collapse) Cath Lab RN/
monitor and automatic BP cuff. Document vitals q 5 min. 2. Call Rapid Response Team or Code BLUE if indicated. 3. Increase IV fluids using normal saline solution.. 4. Oxygen by non-rebreather mask at 10-15 L/M(whatever keeps the reservoir bag inflated). Maintain sats >90%. 5. Order STAT ABG. 6. Monitor BP closely. 7. Call CODE BLUE and initiate CPR, follow ACLS protocol if indicated. HYPERTENSIVE CRISIS monitor and automatic BP cuff. Assess neurologic status and document with vitals q. 5 min. 2. Oxygen by nasal cannula at 1-2 L/M. Maintain sats > 90%. 3. Initiate IV fluids with NSS at KVO rate. 1. Labetalol HCL - Dosing range 5-20 mg IV slowly over 2 minutes. Recommended dose is 5 mg IV and may repeat q 5 minutes up to 4 doses Do not give if HR less than 60 beats per minute. OR 2. Hydralazine HCL - 10 mg IV slowly at a rate of 5 mg/minute. May repeat q 5 minutes x 3 doses. 3. Furosemide 40 mg IV slowly (over minimum of one minute). SEIZURES/ CONVULSIONS 1. Turn patient on side to avoid aspiration. Maintain open airway, suction if necessary. 2. Call Rapid Response Team or Code BLUE if indicated. 3. Oxygen by nasal cannula at 1-2 L/M. Maintain sat > 90%. 4. Page Respiratory and order ABG if indicated. 5. Initiate IV fluids with NSS at KVO rate. 1. If due to hypotension or bradycardia, treat cause of hypotension. 2. Diazepam 5 mg IV slowly for seizures. V. ATTACHMENTS VI. POLICY REFERENCE (if appropriate)
VII. RELATED POLICIES