Cite this post as:
Scott Weingart, MD FCCM. Podcast 103 – Avoiding Resuscitation Medication Errors – Part II. EMCrit Blog. Published on July 21, 2013. Accessed on June 9th 2023. Available at [https://emcrit.org/emcrit/avoiding-resuscitation-medication-errors-2/ ].
Financial Disclosures:
Dr. Scott Weingart, Course Director, reports no relevant financial relationships with ineligible companies.
This episode’s speaker(s), (listed above), report no relevant financial relationships with ineligible companies.
CME Review
Original Release: July 21, 2013
Date of Most Recent Review: Jan 1, 2022
Termination Date: Jan 1, 2025
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Dr. Weingart, Great podcast this week. I would like to comment on the issue of infusion dead space. Pediatric intensive care nurses and neonatal intensive care nurses have known for quite a long time that infusion dead space drastically affects the hemodynamic status of their patients. For example when giving an epinepherine drip to a 5 kg child the drug takes forever to hit the circulatory system. Additionally the pulsatile motion of the infusion pump can cause labile hemodynamics. I currently use a trick that I learned in the pediatric intensive care unit and applied it to adults as well… Read more »
great tip!
Hi Scott,
Great podcast, thanks.
Some RNs at my shop will tape the vial to the syringe after drawing up a drug (with the name of the drug showing – it looks a bit like that picture of ROCKETamine from SMACC). I like this because it’s easy to pick up the syringe later and see exactly what is in it. Relatively quick and idiot-proof, no messy handwriting. I take no credit for this idea, just passing it along.
Best,
Josh
Agreed.
Any time things get a little messy in the truck (especially with RSI), I just tape the vial to the syringe after it’s drawn up. The translucent TransPore tape turns nice and transparent after it’s applied, so you can read the label right through it. The only trick is to make sure that both the concentration on the vial and the volume decrements on the syringe are clearly visible. But that gets easy enough with a little practice.
I have seen this as well; it does solve some issues so long as the clear tape is used. I’m not a huge fan due to the awkwardness of the resulting syringes, but it is not a bad stopgap measure. Thanks for bringing it to the discussion.
Great Podcast! Since the opiate hazed patients occasionally manage to get combative merely from hearing the word “naloxone,” as well as occasionally go into florid withdrawal, I have for years used the “Narcan nebulizer”…throw diluted naloxone in a nebulizer and run it ’til there is an adequate respiratory rate. Everyone stays mellow and happy.
yup
Just a quick note on the priming of insulin tubing- it was written into protocol at my prior job in a Neuro-Medical ICU in Philly to prime IV tubing with 20mL of insulin prior to starting the infusion. Many of our nurses seemed to be unaware of this. This probably resulted in part of the reason they became fed up with the constant adjustment of their insulin infusions wether for DKA or glycemic control.
Great podcast. An error I have seen is pushing an IV medication through a Levophed line by mistake. Thereby giving a large bolus of Levophed. I like to put tape over (or next to) the most distal IV port to mitigate this risk. Another rare but trouble error I have seen as well is mixing up a secondary line. The Levophe bag was removed (thinking it is something else) and a Vancomycin bag was connected. All was well until the Vancomycin filled the line and the BP tanked. Staff increased the dose but nothing was happening until it was discover… Read more »
Yep, agree with all of that and have seen those same errors myself.
Just a quick note about this great pod cast. I always pick up something new, but when I asked about the insulin leaching with in our hospital the comments I recieved back were interesting at best. One was “oh that was nitro and we worked that out years ago” to “I never do this”. Since I feel I am a newer RN and had never heard this before I am confused. I will continue to research to find out the whys and wherefores. Thank you for peaking my interest in this. I look forward to the next cast. I will… Read more »
show them the article
Agree re small doses of IV naloxone. Recent attendance at CEM poisons study day in the UK confirmed this should be our MO when it comes to dealing with opiate poisoned patients.
Now I just need to convince a hell of a lot of my ED Doc and nursing colleagues to put down the big slamming dose of IM!!
NB never heard of the nebulised route: is there much evidence base to it?absorbtion of nebulised naloxone? I like the sound of it!
I asked around the other nurses in our adult/paed ICU in Newy, Australia regarding knowledge of insulin line priming…seemingly a new concept to all, and nada mention in our protocol. Will email our (very diligent) pharmacist with the articles, cheers. However, we run our infusions almost exclusively via 50mL syringe drivers…so will lose most of infusion or maybe need to make up 2? Bummer for workload/plastic consumption.
insulin is dirt cheap, so may be worth it to just mix up one 20 ml syringe to flush the line and then start your infusion with the 50
DIABETES TECHNOLOGY & THERAPEUTICS
Volume 14, Number 10, 2012
The Effect of Tubing Dwell Time on Insulin Adsorption
During Intravenous Insulin Infusions
Cecilia D. Thompson
Same, no dwell time, 20mL flush.