Complications of IV Complications of IV drug Therapydrug Therapy

March 2006March 2006

Site of administrationSite of administration

Benefits?Benefits?

Complications?Complications?

What do you give apart from the What do you give apart from the drug?drug?

FluidFluid– RenalRenal– LiverLiver

DextroseDextrose– diabeticdiabetic

SodiumSodium– LiverLiver– Normal values? 135-145 mmol/lNormal values? 135-145 mmol/l

Foreign BodiesForeign Bodies

Glass fragmentsGlass fragments

Needle sizeNeedle size

Filter needlesFilter needles

Reconstitution Reconstitution devicesdevices

AllergiesAllergies LatexLatex Penicillin…. Which of these Penicillin…. Which of these

antibiotics contain penicillin?antibiotics contain penicillin?– Amoxicillin? Amoxicillin? – Co amoxiclav (Augmentin)? Co amoxiclav (Augmentin)? – Co-trimoxazole (septrin)? Co-trimoxazole (septrin)? – Tazocin? Tazocin? – Gentamicin? Gentamicin?

SpeedshockSpeedshock

Rapid administration of a drugRapid administration of a drug Toxic levels in the bloodToxic levels in the blood Floods organs rich in blood, i.e heart, Floods organs rich in blood, i.e heart,

liver, brainliver, brain Fainting, shock and cardiac arrestFainting, shock and cardiac arrest

A patient is prescribed 1g of Vancomycin. You know A patient is prescribed 1g of Vancomycin. You know

it should be given over 2 hours but the patient has it should be given over 2 hours but the patient has

to go to scan so you run it through quickly. Shortly to go to scan so you run it through quickly. Shortly

after it’s completion you notice that the patient has after it’s completion you notice that the patient has

a rash and is itchy.a rash and is itchy.

What has happened? What has happened? Red man syndromeRed man syndrome How could this have been prevented?How could this have been prevented?

PhlebitisPhlebitis

Irritant medicationsIrritant medications Cannula too bigCannula too big Cannula not Cannula not

securedsecured

InfiltrationInfiltration

Leakage of fluid from the vein to the Leakage of fluid from the vein to the surrounding tissues.surrounding tissues.

Caused by cannula piercing the Caused by cannula piercing the vessel wall.vessel wall.

Pain, paraesthesia, coldPain, paraesthesia, cold Prevention?Prevention? Treatment?Treatment?

ExtravasationExtravasation

Leakage of a Leakage of a vesicant fluid into vesicant fluid into surrounding tissues.surrounding tissues.

E.g. E.g. cytotoxic, sodium cytotoxic, sodium bicarbonate, phenytoin, bicarbonate, phenytoin, dopamine, calcium chloride, dopamine, calcium chloride, potassium, amiodarone) potassium, amiodarone)

TreatmentTreatment– Stop infusionStop infusion– Leave cannula inLeave cannula in– Mark areaMark area– Seek medical adviceSeek medical advice

ErrorsErrors

April-June 2005 = 158 incidentsApril-June 2005 = 158 incidents– 112 had an impact on the patient112 had an impact on the patient– 3 = serious3 = serious

CHECK CHECK Right patientRight patientRight drugRight drugRight routeRight routeRight doseRight doseRight time / rateRight time / rate

PumpsPumps

Many errors are pump relatedMany errors are pump related Pump trainingPump training If you don’t know ASKIf you don’t know ASK If you think you know CHECKIf you think you know CHECK

1902 Richet & porter 1902 Richet & porter – Ana = against, prophylaxis = Ana = against, prophylaxis =

protectionprotection– Disordered reactions of immune Disordered reactions of immune

systemsystem– Due toDue to

DrugsDrugsNutsNutsShell fishShell fish InsectsInsects latexlatex

Major allergens causing severe Major allergens causing severe anaphylaxisanaphylaxis

Anaphylaxis and DrugsAnaphylaxis and Drugs

amoxycillin

Cephalosporins

Other antibioticsNSAIDS

Paracetamol

Iodine

Latex

others

How is it caused?How is it caused?

Allergen causes mast cells to Allergen causes mast cells to produce histamine and other produce histamine and other mediatorsmediators– Bronchoconstriction > DyspnoeaBronchoconstriction > Dyspnoea– Angiooedema (swelling of the head and Angiooedema (swelling of the head and

neck)neck)– Vasodilation > HypotensionVasodilation > Hypotension– Skin reactions > rashesSkin reactions > rashes

TreatmentTreatment Emergency, most serious symptom Emergency, most serious symptom

first, ABCfirst, ABC AirwayAirway

– Maintain, ? Intubate, adrenaline 0.5mg Maintain, ? Intubate, adrenaline 0.5mg IMIM

BreathingBreathing– 100%O2100%O2

CirculationCirculation– Restore, adrenaline 0.5mg IMRestore, adrenaline 0.5mg IM– Fluids…Which onesFluids…Which ones

Immediate actionsImmediate actions

Remove allergenRemove allergen Call for helpCall for help 0.5mg adrenaline IM0.5mg adrenaline IM 100% O2 via trauma mask100% O2 via trauma mask Fluids if neededFluids if needed Later chlorpheniramine (10-20mg Later chlorpheniramine (10-20mg

IM)and Hydrocortisone(100-500mg IM)and Hydrocortisone(100-500mg IM)IM)

Reporting of adverse eventsReporting of adverse events

SummarySummary

When giving a drug IV ThinkWhen giving a drug IV Think– Route central or peripheralRoute central or peripheral– Bolus or intermittentBolus or intermittent

Allergies and interactionsAllergies and interactions Report adverse events of black Report adverse events of black

triangle drugstriangle drugs

ReferencesReferences

Sivagnanam S, Deleu D (2003) Red Sivagnanam S, Deleu D (2003) Red man syndrome man syndrome Critical CareCritical Care 7 119- 7 119-120120

RCN IV Forum (2005) Standards for RCN IV Forum (2005) Standards for IV infusion therapyIV infusion therapy

Resuscitation Council UK Resuscitation Council UK – www.resus.org.ukwww.resus.org.uk