Transcript Complications of IV drug Therapy

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