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Download Hydroxocobalamin - Queensland Ambulance Service
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Drug Therapy Protocols: Hydroxocobalamin Disclaimer and copyright ©2016 Queensland Government All rights reserved. Without limiting the reservation of copyright, no person shall reproduce, store in a retrieval system or transmit in any form, or by any means, part or the whole of the Queensland Ambulance Service (‘QAS’) Clinical practice manual (‘CPM’) without the prior written permission of the Commissioner. The QAS accepts no responsibility for any modification, redistribution or use of the CPM or any part thereof. The CPM is expressly intended for use by QAS paramedics when performing duties and delivering ambulance services for, and on behalf of, the QAS. Under no circumstances will the QAS, its employees or agents, be liable for any loss, injury, claim, liability or damages of any kind resulting from the unauthorised use of, or reliance upon the CPM or its contents. While effort has been made to contact all copyright owners this has not always been possible. The QAS would welcome notification from any copyright holder who has been omitted or incorrectly acknowledged. All feedback and suggestions are welcome, please forward to: [email protected] Date April, 2017 Purpose Scope Author To ensure a consistent procedural approach to Hydroxocobalamin administration. Applies to all QAS clinical staff. Clinical Quality & Patient Safety Unit, QAS Review date April, 2019 Information security This document has been security classified using the Queensland Government Information Security Classification Framework (QGISCF) as UNCLASSIFIED and will be managed according to the requirements of the QGISF. URL https://ambulance.qld.gov.au/clinical.html This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-nd/4.0/. Hydroxocobalamin April, 2017 Drug class Side effects Antidote UNCONTROLLED WHEN PRINTED Pharmacology Hydroxocobalamin (an injectable form of vitamin B12) is an antidote for cyanide toxicity. It binds with circulating and cellular cyanide to form cyanocobalamin, which is then excreted in the urine.[1-4] • Chromaturia • Erythema • Rash (acne like) • Hypertension Metabolism Excreted by the • Anaphylaxis • Nausea and/or vomiting kidneys[1] • Pain at infusion site UNCONTROLLED WHEN PRINTED Indications Presentation • Suspected cyanide toxicity • Vial, 5 g hydroxocobalamin (Cyanokit®)[5,6] UNCONTROLLED WHEN PRINTED Contraindications Onset (IV) Duration (IV) Half-life Immediate Several days 26–31 hours • KSAR or hypersensitivity to hydroxocobalamin Precautions UNCONTROLLED WHEN PRINTED • Hypertension Figure 4.22 QUEENSLAND AMBULANCE SERVICE 831 Hydroxocobalamin Schedule Special notes (cont.) • N/A – TGA Special Access Scheme. Routes of administration • All parenteral medications must be prepared in an aseptic manner. The rubber stopper of all vials must be disinfected with with 2% Chlorhexidine/70% Isopropyl Alcohol swab and allowed to dry prior to piercing. E CCP Intravenous infusion (IV INF) E ACP2 UNCONTROLLED WHEN PRINTED Special notes • All hydroxocobalamin infusions are to be initiated using industry supplied stock. Hydroxocobalamin will not be procured by QAS. • All cannulae and IV lines must be flushed thoroughly with sodium chloride 0.9% following each medication administration. UNCONTROLLED WHEN PRINTED • Hydroxocobalamin is only to be administered by appropriately trained QAS paramedics within the following response catchments: - Mt Isa mine, George Fisher and Earnest Henry mines (North West LASN); and - Orica Yarwun Cyanide Plant (Central Queensland LASN). Adult dosages Suspected cyanide toxicity UNCONTROLLED WHEN PRINTED * Please note dilutant is NOT included. E CCP - one 250 mL glass vials containing 5 g lyophilised hydroxocobalamin for injection, - one sterile transfer spike, - one sterile vented infusion set, - one quick use reference guide and one package insert. E ACP2 • Each Cyanokit® contains the following components: IV INF 5 g over 15 minutes. Paediatric dosages UNCONTROLLED WHEN PRINTED • Cyanokit® vials should be visually inspected for particulate matter and correct colouring prior to administration – if particulate matter is present or the solution is not dark red the solution must be discarded. Note: QAS officers are NOT authorised to administer hydroxocobalamin to paediatric patients. QUEENSLAND AMBULANCE SERVICE 832 Cyanokit® Preparation / Administration Instructions STEP 1 – Reconstitute STEP 3 – INFUSE VIAL Add 100 mL of sodium chloride 0.9% to the 5 g hydroxocobalamin vial using the transfer spike (supplied) – fill to the line with the vial in upright position Use the vented IV infusion tubing (supplied) to hang and administer over 15 minutes. UNCONTROLLED WHEN PRINTED UNCONTROLLED WHEN PRINTED UNCONTROLLED WHEN PRINTED STEP 2 – Mix Rock or rotate the vial for 20 seconds to mix solution – DO NOT SHAKE. UNCONTROLLED WHEN PRINTED QUEENSLAND AMBULANCE SERVICE 833
