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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? 135-145 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 Right Right Right Right patient drug route dose 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 Other antibiotics NSAIDS Paracetamol Iodine Cephalosporins Latex others amoxycillin 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, first, ABC Airway most serious symptom – 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(100-500mg 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 7 119120 RCN IV Forum (2005) Standards for IV infusion therapy Resuscitation Council UK – www.resus.org.uk