Nurses Reconsider Accepted Wisdom About Transfusion Catheter Size

By Betsy Todd, MPH, RN, CIC, AJN clinical editor.

Photo copyright Thinkstock. Photo copyright Thinkstock.

Most of us have had the unhappy experience of replacing a patient’s perfectly good IV with a 19- or 20-gauge catheter in preparation for transfusion. The Question of Practice column in our December issue, “Changing Blood Transfusion Policy and Practice,” explores the rationale behind the long-time practice of using only large-bore catheters for blood transfusions.

After one patient’s particularly harrowing series of sticks to place a “large enough” catheter, a small team of oncology nurses asked themselves, “What evidence supports the use of a 20-gauge-or-larger catheter for blood transfusions?”

Most of these nurses had little experience with formal literature searches. Under the guidance of their clinical nurse specialist, they formulated a “PICOT” question (Population, Intervention, Comparison intervention, Outcome, and Time):

In adults receiving blood transfusions (P), what is the effect of using a smaller-than-20-gauge catheter (I) versus using a 20-gauge-or-larger catheter (C) on hemolysis or potassium level or both (O) within 24 hours of transfusion (T)? (Many of us were taught that a larger-bore catheter is necessary in order to prevent hemolysis during transfusion. Potassium is released when red blood cells rupture.)

The nurses set out to explore the literature and the guidelines of authoritative sources such as the Infusion Nurses Society. But they weren’t left to work […]

2016-11-21T13:03:20-05:00December 17th, 2014|Nursing, nursing perspective, nursing research|9 Comments
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And You Thought PE Was Another Name for Gym Class

By Jacob Molyneux, senior editor

The template goes something like this: Start with a legitimate quality-of-life issue — like fitful sleep or shyness — that does not yet have its own prescription medication and is debilitating to a few people a lot of the time. Next, position the quality-of-life issue as a medical condition with symptoms so common it covers vast numbers of people who had previously not identified themselves as having a health problem, or who thought they were just experiencing an occasional and normal annoyance.

According to the rest of this article in the NY Times, the latest disorder about to enter our dictionary of accepted medical conditions is premature ejaculation (PE). Several companies are developing treatments in the form of pills or aerosol sprays. The net of nonspecific symptoms seems to have been cast fairly wide—a representative of one drug company is quoted as saying that one in three men have this condition. 

Celebrities may soon be confessing that the anxiety occasioned by PE has led to ruined marriages, depression, drug use, and even the use of prostitutes. The ironies of the media campaign to push the term PE into our medical lexicon are worth considering as our legislators debate health care reform provisions and the crisis of rising costs. Medical bankruptcy is on the rise. Many cannot afford medications they need for serious conditions like heart disease and diabetes.

It may be premature to suggest it, but it seems likely the pharmaceutical companies expect health care reform legislation […]

2016-11-21T13:20:37-05:00December 14th, 2009|health care policy|0 Comments
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Why Don’t Drug Labels Make the Actual Harms and Benefits Clear?

By Jacob Molyneux, blog editor/senior editor

How can we know if a drug really works? Gary Schwitzer, publisher of HealthNewsReview.org (an incisive Website that grades the quality of health news reporting) addresses this question on his blog this week by drawing attention to a recent perspective piece published in the New England Journal of Medicine (NEJM). It’s called “Lost in Transmission — FDA Drug Information That Never Reaches Clinicians” and it states the problem clearly:

The 2009 federal stimulus package included $1.1 billion to support comparative-effectiveness research about medical treatments. No money has been allocated — and relatively little would be needed — to disseminate existing but practically inaccessible information about the benefits and harms of prescription drugs. Much critical information that the Food and Drug Administration (FDA) has at the time of approval may fail to make its way into the drug label and relevant journal articles.

The most direct way that the FDA communicates the prescribing information that clinicians need is through the drug label. Labels, the package inserts that come with medications, are reprinted in the Physicians’ Desk Reference and excerpted in electronic references. To ensure that labels do not exaggerate benefits or play down harms, Congress might have required that the FDA or another disinterested party write them. But it did not. Drug labels are written by drug companies, then negotiated and approved by the FDA.

One example given in the NEJM article is the sleeping pill Lunesta:

Clinicians who are interested in (Lunesta’s) efficacy cannot find efficacy information in […]

2016-11-21T13:21:34-05:00October 22nd, 2009|health care policy|0 Comments
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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