Discussion in 'ALS Discussion' started by E tank, Sep 8, 2018.
Thats a lot of NS for that reason...
I'm not saying you're wrong. I'll follow up with the clinical ed guy and see what he says specifically
Is plasmalyte compatible with for most/all med administration? Anyone have any idea what the unit cost is?
I don't give large boluses to bleeding patients, I take them to blood (helicopter, local ED, etc). Sometimes septic and anaphylactic patients get large boluses of NS but I don't think that's necessarily proven to be bad? Is the cost worth it to have other solutions for the rare bleeding patient in need of blood yet you can't get to it? I don't know.
I recently priced unit costs at retail price from Boundtree, our medical supplier. These approximate costs do not reflect our bulk purchasing agreement discount...
Normal saline: $9/1L bag
LR: $11/1L Bag
PlasmaLyte: $25/1L Bag
There is enough controversy to cause a fair amount of investigation in comparing NS to stuff like plasmalyte et al...I think one thing that isn't controversial is that kidneys don't like a lot of chloride ion. At the end of the day, if you're not giving a lot of fluid (>2L?) it doesn't matter. But in situations of a real acidosis, that require volume, a solution with a pH of 7.4 is better than one with a pH of 5. Managing the acidosis is a lot easier, at least in the short term.
I asked a few people why they would use the NS and not the PlasmaLyte, each said "TKO"
A saline lock is cheaper...
The Vanderbilt study showed more long term kidney dysfunction with NS over LR in adult sepsis patients. They are also prone to organ dysfunction as part of their disease process so I don't know if the same would apply to anaphylaxis.
A lot of NS isn't a good choice if you have something else available. If it isn't good for burns, it isn't good for anyone else that needs a lot.
We use locks
Where I work, we primarily use NS for our initial resus. What I personally would like to see is us switch fluids from NS to something else like LR or Plasmalyte after the first 2 liters. What I'd also like to see is actually reducing the amount of fluids administered in total. That's not likely to happen any time soon though. They're not too concerned with dumping in 3-4 (or more) liters of NS in a patient that's hypotensive. I suspect they figure if the patient survives, they can just diurese the patient later... and let the ICU deal with that problem.
What do I know, I'm just an RN/Medic...
What county in California did that?
In Riverside County we took out Dopamine well over 8 years ago. In the past 3 years we have also only been starting IVs on patients that: we give fluids, we give medications, have a high potential of crashing. We no longer start curiosity IVs. Even if we know this patient will get an IV at the ED we do not start it.
ICEMA recently took Dopamine off of their standard equipment list.
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