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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

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Complications of IV drug Therapy

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  1. Complications of IV drug Therapy March 2006

  2. Site of administration Benefits? Complications?

  3. What do you give apart from the drug? • Fluid • Renal • Liver • Dextrose • diabetic • Sodium • Liver • Normal values? 135-145 mmol/l

  4. Foreign Bodies • Glass fragments • Needle size • Filter needles • Reconstitution devices

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

  6. 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

  7. 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?

  8. Phlebitis • Irritant medications • Cannula too big • Cannula not secured

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

  10. 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

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

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

  13. 1902 Richet & porter • Ana = against, prophylaxis = protection • Disordered reactions of immune system • Due to • Drugs • Nuts • Shell fish • Insects • latex

  14. Major allergens causing severe anaphylaxis

  15. Anaphylaxis and Drugs

  16. 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

  17. 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

  18. 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)

  19. Reporting of adverse events

  20. Any Questions?

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

  22. References • Sivagnanam S, Deleu D (2003) Red man syndrome Critical Care 7 119-120 • RCN IV Forum (2005) Standards for IV infusion therapy • Resuscitation Council UK • www.resus.org.uk

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