A Survey to Inform Standardisation of Intravenous Medication Concentrations in Critical Care

Borthwick, Mark; Woods, Justin; Keeling, Susan; Keeling, Peter; Waldmann, Carl

doi:10.1177/175114370700800134

Cited by 10 publications

(16 citation statements)

References 7 publications

(9 reference statements)

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“…Many agree in practice but few are willing to compromise to achieve this goal. The nature of the challenge was clearly identified in 2007 [3] but change has been slow. For example, the NHS 'consensus' about preferred presentations of potassium chloride infusions, the subject of the first NPSA Safety Alert in 2007, seems to be divided roughly equally into at least three concentrations (20, 40 and 50 mmol.50 ml ) and two container types (bags or syringes) [4].…”

mentioning

confidence: 99%

Comparing sugammadex and neostigmine reversal of neuromuscular blockade in laparoscopic surgery

Jain

Gandhi

2013

Anaesthesia

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confidence: 99%

Comparing sugammadex and neostigmine reversal of neuromuscular blockade in laparoscopic surgery

Jain

Gandhi

2013

Anaesthesia

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“…Internationally recognised guidelines for the setting up of such infusions do not appear to exist (although it is our understanding that this is currently being looked at by the intensive care society) and there is wide variability in the concentrations and infusion rates used. 3 Of the local and textbook guidelines available to us it would appear that line dead space is potentially a problem in the administration of inotropes, sedatives, muscle relaxants and heparin, although none of the guidelines we looked at had initial rates as low as those commonly used for nitrates (most initial low infusion rates were between 2-5 ml/h).…”

Section: Discussionmentioning

confidence: 99%

Peripheral line dead space: an unrecognised phenomenon?

Geggie

Moore

2007

Emergency Medicine Journal

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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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“…Internationally surveys, interrogation of infusion device libraries and point prevalence studies have demonstrated significant variability in commonly administered ICU medications . A common source of variability is the range of final concentrations of preparations; however, variability extends across all aspects of purchasing, preparation, labelling and dosing nomenclature.…”

Section: Introductionmentioning

confidence: 99%

Variability of intravenous medication preparation in Australian and New Zealand intensive care units

Levkovich

Bui

Bovell

et al. 2016

Evaluation Clinical Practice

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A Survey to Inform Standardisation of Intravenous Medication Concentrations in Critical Care

Abstract: Graph 1: Number of presentations in use per medication in 154 UK critical care units by guest on June 1, 2015 inc.sagepub.com Downloaded from

Cited by 10 publications

References 7 publications

Comparing sugammadex and neostigmine reversal of neuromuscular blockade in laparoscopic surgery

Comparing sugammadex and neostigmine reversal of neuromuscular blockade in laparoscopic surgery

Peripheral line dead space: an unrecognised phenomenon?

Variability of intravenous medication preparation in Australian and New Zealand intensive care units

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