complications of iv drug therapy march 2006. site of administration benefits?complications?
TRANSCRIPT
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Complications of IV Complications of IV drug Therapydrug Therapy
March 2006March 2006
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Site of administrationSite of administration
Benefits?Benefits?
Complications?Complications?
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What do you give apart from the What do you give apart from the drug?drug?
FluidFluid– RenalRenal– LiverLiver
DextroseDextrose– diabeticdiabetic
SodiumSodium– LiverLiver– Normal values? 135-145 mmol/lNormal values? 135-145 mmol/l
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Foreign BodiesForeign Bodies
Glass fragmentsGlass fragments
Needle sizeNeedle size
Filter needlesFilter needles
Reconstitution Reconstitution devicesdevices
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AllergiesAllergies LatexLatex Penicillin…. Which of these Penicillin…. Which of these
antibiotics contain penicillin?antibiotics contain penicillin?– Amoxicillin? Amoxicillin? – Co amoxiclav (Augmentin)? Co amoxiclav (Augmentin)? – Co-trimoxazole (septrin)? Co-trimoxazole (septrin)? – Tazocin? Tazocin? – Gentamicin? Gentamicin?
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SpeedshockSpeedshock
Rapid administration of a drugRapid administration of a drug Toxic levels in the bloodToxic levels in the blood Floods organs rich in blood, i.e heart, Floods organs rich in blood, i.e heart,
liver, brainliver, brain Fainting, shock and cardiac arrestFainting, shock and cardiac arrest
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A patient is prescribed 1g of Vancomycin. You know A patient is prescribed 1g of Vancomycin. You know
it should be given over 2 hours but the patient has it should be given over 2 hours but the patient has
to go to scan so you run it through quickly. Shortly to go to scan so you run it through quickly. Shortly
after it’s completion you notice that the patient has after it’s completion you notice that the patient has
a rash and is itchy.a rash and is itchy.
What has happened? What has happened? Red man syndromeRed man syndrome How could this have been prevented?How could this have been prevented?
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PhlebitisPhlebitis
Irritant medicationsIrritant medications Cannula too bigCannula too big Cannula not Cannula not
securedsecured
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InfiltrationInfiltration
Leakage of fluid from the vein to the Leakage of fluid from the vein to the surrounding tissues.surrounding tissues.
Caused by cannula piercing the Caused by cannula piercing the vessel wall.vessel wall.
Pain, paraesthesia, coldPain, paraesthesia, cold Prevention?Prevention? Treatment?Treatment?
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ExtravasationExtravasation
Leakage of a Leakage of a vesicant fluid into vesicant fluid into surrounding tissues.surrounding tissues.
E.g. E.g. cytotoxic, sodium cytotoxic, sodium bicarbonate, phenytoin, bicarbonate, phenytoin, dopamine, calcium chloride, dopamine, calcium chloride, potassium, amiodarone) potassium, amiodarone)
TreatmentTreatment– Stop infusionStop infusion– Leave cannula inLeave cannula in– Mark areaMark area– Seek medical adviceSeek medical advice
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ErrorsErrors
April-June 2005 = 158 incidentsApril-June 2005 = 158 incidents– 112 had an impact on the patient112 had an impact on the patient– 3 = serious3 = serious
CHECK CHECK Right patientRight patientRight drugRight drugRight routeRight routeRight doseRight doseRight time / rateRight time / rate
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PumpsPumps
Many errors are pump relatedMany errors are pump related Pump trainingPump training If you don’t know ASKIf you don’t know ASK If you think you know CHECKIf you think you know CHECK
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1902 Richet & porter 1902 Richet & porter – Ana = against, prophylaxis = Ana = against, prophylaxis =
protectionprotection– Disordered reactions of immune Disordered reactions of immune
systemsystem– Due toDue to
DrugsDrugsNutsNutsShell fishShell fish InsectsInsects latexlatex
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Major allergens causing severe Major allergens causing severe anaphylaxisanaphylaxis
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Anaphylaxis and DrugsAnaphylaxis and Drugs
amoxycillin
Cephalosporins
Other antibioticsNSAIDS
Paracetamol
Iodine
Latex
others
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How is it caused?How is it caused?
Allergen causes mast cells to Allergen causes mast cells to produce histamine and other produce histamine and other mediatorsmediators– Bronchoconstriction > DyspnoeaBronchoconstriction > Dyspnoea– Angiooedema (swelling of the head and Angiooedema (swelling of the head and
neck)neck)– Vasodilation > HypotensionVasodilation > Hypotension– Skin reactions > rashesSkin reactions > rashes
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TreatmentTreatment Emergency, most serious symptom Emergency, most serious symptom
first, ABCfirst, ABC AirwayAirway
– Maintain, ? Intubate, adrenaline 0.5mg Maintain, ? Intubate, adrenaline 0.5mg IMIM
BreathingBreathing– 100%O2100%O2
CirculationCirculation– Restore, adrenaline 0.5mg IMRestore, adrenaline 0.5mg IM– Fluids…Which onesFluids…Which ones
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Immediate actionsImmediate actions
Remove allergenRemove allergen Call for helpCall for help 0.5mg adrenaline IM0.5mg adrenaline IM 100% O2 via trauma mask100% O2 via trauma mask Fluids if neededFluids if needed Later chlorpheniramine (10-20mg Later chlorpheniramine (10-20mg
IM)and Hydrocortisone(100-500mg IM)and Hydrocortisone(100-500mg IM)IM)
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Reporting of adverse eventsReporting of adverse events
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SummarySummary
When giving a drug IV ThinkWhen giving a drug IV Think– Route central or peripheralRoute central or peripheral– Bolus or intermittentBolus or intermittent
Allergies and interactionsAllergies and interactions Report adverse events of black Report adverse events of black
triangle drugstriangle drugs
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ReferencesReferences
Sivagnanam S, Deleu D (2003) Red Sivagnanam S, Deleu D (2003) Red man syndrome man syndrome Critical CareCritical Care 7 119- 7 119-120120
RCN IV Forum (2005) Standards for RCN IV Forum (2005) Standards for IV infusion therapyIV infusion therapy
Resuscitation Council UK Resuscitation Council UK – www.resus.org.ukwww.resus.org.uk