Complications of IV drug Therapy March 2006

Site of administration Benefits?Complications?

What do you give apart from the drug?  Fluid –Renal –Liver  Dextrose –diabetic  Sodium –Liver –Normal values? mmol/l

Foreign Bodies Glass fragments Needle size Filter needles Reconstitution devices

Allergies  Latex  Penicillin…. Which of these antibiotics contain penicillin? –Amoxicillin? –Co amoxiclav (Augmentin)? –Co-trimoxazole (septrin)? –Tazocin? –Gentamicin?

Speedshock  Rapid administration of a drug  Toxic levels in the blood  Floods organs rich in blood, i.e heart, liver, brain  Fainting, shock and cardiac arrest

A patient is prescribed 1g of Vancomycin. You know it should be given over 2 hours but the patient has to go to scan so you run it through quickly. Shortly after it’s completion you notice that the patient has a rash and is itchy.  What has happened?  Red man syndrome  How could this have been prevented?

Phlebitis  Irritant medications  Cannula too big  Cannula not secured

Infiltration  Leakage of fluid from the vein to the surrounding tissues.  Caused by cannula piercing the vessel wall.  Pain, paraesthesia, cold  Prevention?  Treatment?

Extravasation  Leakage of a vesicant fluid into surrounding tissues.  E.g. cytotoxic, sodium bicarbonate, phenytoin, dopamine, calcium chloride, potassium, amiodarone)  Treatment –Stop infusion –Leave cannula in –Mark area –Seek medical advice

Errors  April-June 2005 = 158 incidents –112 had an impact on the patient –3 = serious CHECK Right patient Right patient Right drug Right drug Right route Right route Right dose Right dose Right time / rate Right time / rate

Pumps  Many errors are pump related  Pump training  If you don’t know ASK  If you think you know CHECK

 1902 Richet & porter –Ana = against, prophylaxis = protection –Disordered reactions of immune system –Due to  Drugs  Nuts  Shell fish  Insects  latex

Major allergens causing severe anaphylaxis

Anaphylaxis and Drugs

How is it caused?  Allergen causes mast cells to produce histamine and other mediators –Bronchoconstriction > Dyspnoea –Angiooedema (swelling of the head and neck) –Vasodilation > Hypotension –Skin reactions > rashes

Treatment  Emergency, most serious symptom first, ABC  Airway –Maintain, ? Intubate, adrenaline 0.5mg IM  Breathing –100%O2  Circulation –Restore, adrenaline 0.5mg IM –Fluids…Which ones

Immediate actions  Remove allergen  Call for help  0.5mg adrenaline IM  100% O2 via trauma mask  Fluids if needed  Later chlorpheniramine (10-20mg IM)and Hydrocortisone( mg IM)

Reporting of adverse events

Summary  When giving a drug IV Think –Route central or peripheral –Bolus or intermittent  Allergies and interactions  Report adverse events of black triangle drugs

References  Sivagnanam S, Deleu D (2003) Red man syndrome Critical Care  RCN IV Forum (2005) Standards for IV infusion therapy  Resuscitation Council UK –