Objective: To determine if peripheral intravenous cannula dead space is taken into account when setting up intravenous infusions (in particular nitrate infusions) in the emergency department. Method: A postal survey of UK emergency departments. Results: Of the 143 (58%) of UK departments who responded, only 15% reported priming the cannula before commencing the nitrate infusion. Conclusions: Knowledge of peripheral intravenous cannula dead space in UK emergency departments is very poor and, as a result, there is probably significant widespread under treatment of patients in severe cardiogenic pulmonary oedema. Departments should amend their treatment guidelines to take account of peripheral cannula dead space I ntravenous infusions and bolus doses of drugs are commonly used in emergency medicine. Whereas bolus drugs are nearly always followed with a flush to eradicate residual drugs in the cannula, the personal experience of both the authors was that the lines used to give nitrate infusions are rarely (if ever) primed with the relevant medication in order to take account of their ''dead space''. A current (at time of writing) national trial (the 3CPO trial) makes no mention in its treatment guidelines of priming the peripheral cannula when setting up a nitrate infusion.1 Indeed, its guidelines suggest commencing an infusion at 0.6 mg/h. If a large peripheral (Orange (14G)) cannula was being used this would mean a delay (presuming an infusion concentration of 1 mg/ml) of up to 30 min before any nitrate enters the circulation. If (perhaps more commonly) a green (18G) cannula was being used there would be still be a delay of approximately 20 min. We designed a questionnaire study to look at the current treatment of left ventricular failure/ cardiogenic pulmonary oedema. As part of that questionnaire we asked if intravenous nitrates were routinely used and if cannulas were routinely primed prior to commencing intravenous nitrate infusions.
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