Unique two-stage intervention to modify prescribing trends.

withgoodpalpablepulses.The maintenance ivwasflowing wellin her leftarm. In theevening, loosebilateralwristrestraintswereplacedbecauseof continued seizure activity. At 9 pm the left hand wasalso found to be cyanotic,but with poor pulses on palpation. The next morning, pulseswere poor in both hands and a subclavian catheter was placed for venous access. Her platelet counts were normal, both quantitatively and qualitatively. Both C-3 and C-4 serum concentrations werenormal. The patient's righthand healedwithno residuallossof function. Duringthe three weeks of healing,cyanosis graduallyresolvedafter extensive desquamation. The left hand had persistent cyanosis,and gangrenous changesin the left hand resulted in amputation above the wrist three and one-half weeks after admission.