Unintentional i.v. injection of barium sulfate in a child

Abstract

A 17-month-old girl inadvertently received barium sulfate by i.v. injection through a CVL that was mistaken for the patient's gastrostomy tube.

Tubing Misconnections

“…In May 2010, the accidental injection of barium sulfate through a central venous catheter in a 17-month-old was reported in the American Journal of Health Systems Pharmacists. 64 On July 15, 2010, the ISMP reported that a 19-month-old died after receiving an oral medication through a central line. 78 On a broader perspective, these are clear signals of danger for all of us who use universal connectors; on a human level, these events simply should not have happened.…”

“…The nurse in the case was reported to have pending charges of manslaughter. In May 2010, the accidental injection of barium sulfate through a central venous catheter in a 17‐month‐old was reported in the American Journal of Health Systems Pharmacists 64 . On July 15, 2010, the ISMP reported that a 19‐month‐old died after receiving an oral medication through a central line 78 .…”

“…A redesign to incompatibility is called for by consensus statements and expert groups and is recommended in the majority of case reports. **** ** References 6,7,15,16,20,37,41,42,[48][49][50][51][53][54][55][56][57][58][59][60][61][62][63][64][65] *** References 12,16,39,42,57,58,[66][67][68] **** References 4,6,7,9,10,12,15,16,20,37,[41][42][43][48][49][50][51][53]…”

Examination of radio‐opacity enhancing additives in shape memory polyurethane foams

“…A literature search revealed some attempts at using ZrO 2 in dental applications to better image adhesives . ZrO 2 has been shown to have better cytocompatibility than polyethylene, and has been used in orthopedic applications such as femoral head coatings in total hip replacement devices, with data showing a lower inflammatory response compared to titanium when implanted .…”

“…23,24,28 A literature search revealed some attempts at using ZrO 2 in dental applications to better image adhesives. 18,19,29 ZrO 2 has been shown to have better cytocompatibility than polyethylene, and has been used in orthopedic applications such as femoral head coatings in total hip replacement devices, with data showing a lower inflammatory response compared to titanium when implanted. [30][31][32][33] ZrO 2 -coated surfaces also possess hemocompatibility with decreased time to thrombus formation compared with uncoated surfaces or stainless steel, and could be used for a blood contacting device without inducing toxicity.…”