Crisis management during anaesthesia: vascular access problems

Singleton, Rosalyn; Kinnear, Stephen; Currie, M; Helps, Stephen C.

doi:10.1136/qshc.2002.004507

Cited by 8 publications

(7 citation statements)

References 4 publications

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“…However, later reports would suggest that these incidents are occurring, but may be misclassified. An analysis of the first 4000 incidents in the AIMS database using the search term ‘vascular access’ identified six incidents that described suxamethonium causing late paralysis subsequent to flushing the deadspace of the intravenous line . A report of incidents involving neuromuscular blockade reported to the NRLS between 2006 and 2008 identified incidents described as ‘awareness’ including the following: “ Patient in recovery for two hours.…”

mentioning

confidence: 99%

Residual anaesthesia drugs in intravenous lines – a silent threat?

2013

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confidence: 99%

Residual anaesthesia drugs in intravenous lines – a silent threat?

2013

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“…2 We believe it is a little appreciated phenomenon and rarely compensated for in emergency medicine. As a result, many patients may well be having the treatment of life-threatening conditions substantially delayed.…”

Section: Discussionmentioning

confidence: 98%

Peripheral line dead space: an unrecognised phenomenon?

Geggie

Moore

2007

Emergency Medicine Journal

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Objective: To determine if peripheral intravenous cannula dead space is taken into account when setting up intravenous infusions (in particular nitrate infusions) in the emergency department. Method: A postal survey of UK emergency departments. Results: Of the 143 (58%) of UK departments who responded, only 15% reported priming the cannula before commencing the nitrate infusion. Conclusions: Knowledge of peripheral intravenous cannula dead space in UK emergency departments is very poor and, as a result, there is probably significant widespread under treatment of patients in severe cardiogenic pulmonary oedema. Departments should amend their treatment guidelines to take account of peripheral cannula dead space I ntravenous infusions and bolus doses of drugs are commonly used in emergency medicine. Whereas bolus drugs are nearly always followed with a flush to eradicate residual drugs in the cannula, the personal experience of both the authors was that the lines used to give nitrate infusions are rarely (if ever) primed with the relevant medication in order to take account of their ''dead space''. A current (at time of writing) national trial (the 3CPO trial) makes no mention in its treatment guidelines of priming the peripheral cannula when setting up a nitrate infusion.1 Indeed, its guidelines suggest commencing an infusion at 0.6 mg/h. If a large peripheral (Orange (14G)) cannula was being used this would mean a delay (presuming an infusion concentration of 1 mg/ml) of up to 30 min before any nitrate enters the circulation. If (perhaps more commonly) a green (18G) cannula was being used there would be still be a delay of approximately 20 min. We designed a questionnaire study to look at the current treatment of left ventricular failure/ cardiogenic pulmonary oedema. As part of that questionnaire we asked if intravenous nitrates were routinely used and if cannulas were routinely primed prior to commencing intravenous nitrate infusions.

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“…Because drug administration during anaesthesia is commonly by the intravenous route, this paper should be regarded as a companion to the paper dealing with problems with vascular access which is presented elsewhere in this series. 9 Incidents arising during the course of an anaesthetic may frequently have a component attributable to a drug error, interaction, effect or side effect. The use of COVER in the SCAN and CHECK modes should identify the majority of sequelae from such incidents but, unless a drug (or blood product) or vascular access problem is considered as part of the ABCD sequence and specifically excluded, the cause of the problem may be difficult to determine and therefore to correct.…”

Section: Discussionmentioning

confidence: 99%

“…A ''geographical'' approach to aid in the detection of vascular access problems is presented elsewhere in this series. 9 The corrective strategies required will depend upon the sequelae and range from simple drug cessation or reinstitution through to treatment of specific crisis situations that result from or are associated with the medication error.…”

Section: Discussionmentioning

confidence: 99%