Prevention of
emergencies is always the first line of defense. All potential emergency
situations and proper responses should be discussed and "role-played" with
patients during initial teaching. Ideally, patients should call and visit
their local fire stations, emergency rooms and/or EMS staff to educate them
about their condition, treatment and emergency requirements. If necessary,
a letter can be provided to emergency services about the importance of maintaining
the infusion at all times and via a peripheral vein if necessary. Stickers
are located on the infusion pumps with the patients' dose of epoprostenol
as well as warning stickers to not turn the pump off for any reason. Patients
are also encouraged to wear a medic alert bracelet or carry a laminated card
listing their health problems as well as pump warnings. Since the patients
themselves may be the best information source in emergency situations, approaches
to a number of urgent situations are carefully explained below:
Hickman Catheter
falls out or is pulled out
When the catheter
is out you are not getting your Flolan. This is an emergency.
- If someone
else is around have them call for help.
- Call 911
- While waiting for help to arrive minimize physical activity and put oxygen
on if you have it at home. Cover the area where the catheter fell out with
your hand and apply pressure if bleeding.
- When emergency help arrives, advise them of your condition and that an
IV must be started in your arm. Your pump tubing will screw directly on to
the IV
they put in your arm. Make sure that the pump is running.
- If the emergency personnel are reluctant to place IV or connect medicine,
show them the warning sticker on your pump and call your Flolan provider's
emergency number.
- Remember to take your back-up medication cassette and supplies to the hospital.
- Once you get to the hospital, have them call your PH center or call them
yourself for how to proceed.
You notice
a Fuzzy raised area on the catheter where it comes out of your skin.
The catheter has
a small "cuff" under your skin that is designed to hold the catheter
in place. Over time this cuff sits under your skin and forms a bond between
the skin and muscle. Sometimes the catheter can start coming out, and you
will see this start to appear outside your skin. This is a problem as your
catheter is not secured in your chest and there is an increased chance that
it may fall out. The catheter cannot safely be "pushed" back
in, it may need to be replaced.
- Secure the
catheter with your dressing using extra tape and make several "safety
loops" so it does not accidentally get pulled.
- Call your PH center.
You noticed
drainage or oozing from your catheter.
You may be developing
an infection.
- Call your PH
center.
- Be prepared to tell them what your temperature is, any allergies you have,
when your last infection may have been, and the number for your local pharmacy.
- Also be prepared to visit your PH center or local MD if they need to see
the catheter or take a sample of the drainage.
- Do NOT start taking any antibiotics that you may have at home before talking
to your PH center.
You have a
fever
You may be developing
an infection
- Call your PH
center
- Be prepared to tell them about what your catheter site looks like and any
other symptoms or feelings that you are experiencing.
Your catheter
is leaking or has a crack. Blood or medicine may be leaking out.
You are not getting
your Flolan and this is an emergency.
The catheter might be able to be repaired or need to be replaced. You need to
be getting your Flolan infusion through a vein in your arm until this happens.
- If someone else
is around call for help.
- Call 911
- If blood is backing up in the catheter or leaking out, use your clamp to
close off the catheter to stop blood from backing up. You may attempt to
wrap the crack
or hole tightly with tape, but if it is still leaking you must clamp off
the line.
- While waiting for help to arrive minimize physical activity and put oxygen
on if you have it at home.
- When emergency help arrives, advise them of your condition and that an
IV must be started in your arm. Your pump tubing will screw directly on to
the IV
they put in your arm. Make sure that the pump is running. If the emergency
personnel are reluctant to place IV or connect medicine, show them the warning
sticker
on your pump and call your Flolan provider's emergency number.
- Remember to take your back-up medication cassette and supplies to the hospital.
- Once you get to the hospital, have them call your PH center or call them
yourself for how to proceed.
Tips for traveling
- Take time
to plan ahead and arrange needed refrigeration and freezers. Establish
a back-up
plan should you not make a scheduled connection or get to you
final destination on time.
- If you are going for an extended stay, have your Flolan supplier ship the
majority of your supplies there ahead of time.
- Always carry your medication, supplies and back-up pump in the passenger
section of a car (not in trunk) and as carry-on on an airplane. You may need
a letter
from your PH center to be able to carry supplies (needles) through
airport security.
- Advise your PH center that you will be traveling and review contact numbers.
- Obtain the name and number of a PH physician in that area. Check the PHA
website and\or with your local PH center for names.
- Consider having routine bloodwork done a few days before your trip and
confirm results with your PH center before leaving.
