ProNurse

Not completely true Furrycat. The PGD for administration of instillagel in the trust I work for states that it must be excluded from use in a patient with third degree heart block (complete heart block) and aquagel must be used in this instance.

There are other arrhythmias such as AF where instillagel is not contra-indicated but, of course no drug is completely risk free and that is why we must have annual intermediate life support updates.

Interesting..

I guess that this is because of the risk of systemic absorption of topically applied lignocaine- any anti-arrhythmic has the potential to be pro-arrhythmic, particularly in vulnerable people- however the maximum safe dosage for sub-cutaneous lignocaine is 0.3mg/kg- substantially more than the amount contained in an 11ml installagel preparation.

The BNF says; In patients with severe hypertension or unstable cardiac rhythm, the use of adrenaline in a local anaesthetic may be hazardous- and so I can see where these policies come from- although this has never been a matter of policy/concern where I teach.  The BNF does note that peak plasma concentrations are at about 25mins after application and so I suppose that where the decision to use the product in a vulnerable patient has been made then close monitoring should be considered (hopefully somebody this unstable will already be in a critical care area) I would be reluctant to catheterise without some sort of local anaesthetic - and have always used it- even on critically unwell  and/or unconscious patients-  it's uncomfortable enough even with it.

Jim

The info is out there if you can be arsed to look for it.....Never, ever take the word of a rep.

*disclaimer* This is my opinion only...each rep is accountable to their company...they don't tell untruths  BUT they only ever give the info that suits their brief.

Always dig and delve after a  'Rep' presentation.

You should follow the protocol for the trust you work for.

Then you follow the protocol for the trust you are practicing with. Simples

You are welcome...and well done for raising your concern.

Have you had any problems with your patients?