Study Objective To survey anesthesia providers for their opinion on “best practice” in perioperative peripheral intravenous catheter (PIV) management, and to determine if they follow those opinions. Design Survey instrument. Setting Academic medical center. Subjects 266 United States (US) anesthesia provider respondents [attending anesthesiologists, anesthesiology residents, anesthesia assistants, certified registered nurse-anesthetists (CRNAs), and student registered nurse-anesthetists (SRNAs)]. Measurements Between May 2009 and October 2010 a national survey was distributed to individuals who provide intraoperative anesthesia care to patients. Results were gathered via the SurveyMonkey database. Main Results 266 anesthesia providers from across the U.S. took part in the survey. The majority (70%) had less than 5 years’ experience. Nearly 90% of respondents cared for a patient with an intravenous (IV) catheter infiltration at some point during their training; 7% of these patients required medical intervention. Intravenous assessment and documentation practices showed great variability. Management and documentation of PIVs was more aggressive and vigilant when respondents were asked about "best practice" than about actual management. Conclusion There is no commonly accepted standard for management and documentation of PIVs in the operating room. From our survey, what providers think is "best practice" in the management and documentation of PIVs is not what is being done.

Background Perphenazine is a treatment option in postoperative nausea and vomiting (PONV) prophylaxis. Chronic administration and high dose are known to cause extrapyramidal system (EPS) dysfunction at a frequency of 8%, but the incidence of acute EPS after a single 4 or 8 mg dose is unknown. Objective A retrospective analysis of patient medication billing data and departmental quality records was performed (January 2001 – 10 July 2012) to identify patients who experienced EPS dysfunction after oral perphenazine. Design Retrospective analysis. Setting Surgical outpatients presenting to any one of ten hospitals in the area of Pittsburgh, PA, USA. Patients, other participants Overall, 45,766 patients received 4 or 8 mg of perphenazine before same-day surgery. Main Outcome Measures EPS dysfunction was defined as acute dystonia, akathisia, or pseudoparkinsonism. Records were reviewed to determine the (i) likely number of reactions to perphenazine, (ii) nature of these reactions, and (iii) impact on patient care. Results There were four “likely” cases of EPS dysfunction, and two “possible” cases. Five reported events were consistent with akathisia, with the sixth being a dystonic reaction. All six patients had resolution of symptoms, with five receiving intravenous diphenhydramine for treatment. The incidence of EPS dysfunction was 1.3 events per 10,000 patients (95% CI: 0.4, 3.0, based on 6 events). All patients who experienced reactions preoperatively were able to proceed to surgery without complications or delay. One patient required unplanned admission and 3-hour observation due to sedation from diphenhydramine. The incidence of EPS dysfunction after oral perphenazine is low. Reactions that did occur were mild and easily treated. Conclusions Given the infrequent side-effects, this single, low-dose of perphenazine should be encouraged as a low-risk adjunct to any multimodal PONV prophylaxis regimen, based on the selection criteria described.

No abstract