Accidental Intravenous Administration Research Articles

Death by accidental intravenous administration of gasoline

Death by accidental intravenous administration of gasoline

Aluminium release by coated and uncoated fluid-warming devices.

The use of fluid-warming systems is recommended for infusion rates >500ml.h-1 to avoid peri-operative hypothermia. Some fluid-warming devices use disposable aluminium-heated plates for heat transfer, but there is no protective coating to separate the fluid from the heated aluminium surface. It is unknown if this could promote release of aluminium into infusion fluids. We investigated a coated (Fluido compact) and an uncoated (enFlow) fluid-warming device using normal saline or balanced electrolyte solution as infusion fluids, pumped through the heated disposables at flow rates of 2, 4 and 8ml.min-1 for 60min each. Aluminium concentrations in the fluid samples were analysed using graphite furnace atomic absorption spectrometry. With saline the coated and uncoated devices yielded aluminium concentrations below the level of quantification (<128μg.l-1 ). Similarly, balanced electrolyte solution in the coated device yielded aluminium concentrations <128μg.l-1 . However, balanced electrolyte solution in the uncoated device yielded aluminium concentrations of up to 6794 (3465-8002 [1868-7421]) μg.l-1 . Repeating this last study at a flow rate of 2ml.min-1 resulted in quite high aluminium concentrations when the uncoated device was not heated (~1000μg.l-1 ) and higher concentrations after the device was heated. We conclude that using uncoated aluminium plates in fluid-warming systems can lead to a risk of administering potentially harmful concentrations of aluminium when balanced crystalloid solutions are used. The mechanism is unclear, but heat is in part involved. Coating for aluminium within medical devices in direct contact with infusion fluids should be recommended.

Accidental intravenous administration of paracetamol syrup in a child

Medication administration errors occur frequently in clinical practice. An 18-month-old child presented with vomiting and diarrhea. Due to a rise in temperature, paracetamol syrup was prescribed, but a nurse inadvertently administered the drug IV through the peripheral venous access. The child was referred to the pediatric intensive care unit where his clinical condition improved and the risk of peripheral venous and pulmonary embolism was excluded. The use of specific oral syringes should become a standard of practice in every healthcare organization and more supervision of new nurse graduates is necessary. Also, attention to the relationship with parents should be guaranteed because the communication of medical errors is a highly challenging aspect of these errors.

Inadvertent intravenous administration of maternal breast milk in a six-week-old infant: a case report and review of the literature

BackgroundAccidental intravenous administration of an enteral feeding can be fatal or cause complications such as sepsis, acute respiratory and circulatory failure, acute renal failure, hepatic insufficiency, coagulation disorders and severe permanent neurological sequelae. These “wrong route” errors are possible due to compatible connections between enteral feeding systems and intravascular infusion catheters.Case presentationWe report a six-week-old male infant who received a 5 ml intravenous infusion of breast milk. Within five minutes of administration the child developed tachycardia and tachypnea, accompanied by a sudden decrease in oxygen saturation on pulse oximetry to 69%. The infant received supplemental oxygen via nasal cannula and was transferred to the pediatric intensive care unit. Broad-spectrum antibiotics were administered for 48 hours. Vital signs returned to normal within a few hours. Neurological follow-up through 3 years did not reveal any neurodevelopmental abnormalities.ConclusionDevelopment of specific enteral feeding connections, which are incompatible with intravascular catheter connections, is needed urgently to prevent a misconnection with potential morbidity or mortality of children.

Komplikationen bei peripherer Regionalanästhesie

Peripheral regional anesthesia is a commonly used and safe procedure and eneral complications or side effects are generally rare. Nerve damage has an incidence <0.1% depending on the definition and the prognosis is good. To avoid bleeding complications the national standards of block performance under antithrombotic therapy should be respected. Intoxication is mainly the result of accidental intravenous administration and is difficult to treat but higher doses of intravenous lipid emulsions can improve the outcome. Potential infectious complications can occur mainly as a result of catheter techniques and require a strict aseptic approach. Further rare complications are allergies, dislocation of catheters and knotting or loops in catheters. Besides the general complications, there are some specific complications depending on the puncture site, such as pneumothorax or renal puncture.

Inverted Takotsubo cardiomyopathy following accidental intravenous administration of epinephrine in a young woman

Inverted Takotsubo cardiomyopathy following accidental intravenous administration of epinephrine in a young woman

Normal Neurologic and Developmental Outcome After an Accidental Intravenous Infusion of Expressed Breast Milk in a Neonate

Here we describe a premature male infant who was accidentally given 10 mL of expressed breast milk intravenously over a 3.5-hour period. Having survived this event with supportive care, this boy was attending regular school with no obvious neurologic or learning difficulties at 6 years of age. In 1998, after a query on an e-mail discussion group for health care providers in neonatology (NICU-net), we were informed of 8 similar events that proved fatal in 3 infants. A root-cause analysis revealed that accidental intravenous administration of breast milk or formula can be avoided by the use of color-coded enteral-administration sets with Luer connections that are not compatible with intravenous cannulas. The addition of methylene blue to feeds, or bolus enteral feeds (instead of continuous gastric feedings), may also help prevent such errors. These cases show the value of gathering information about rare but important events through a neonatal network. In addition, they confirm that prevention of medical error should focus on faulty systems rather than faulty people.

Accidental intravenous administration of racemic adrenaline: two cases associated with adverse cardiac effects

Accidental intravenous administration of racemic adrenaline (epinephrine) is a rare but potentially lethal complication. We describe a case of a 68-year-old man with chronic obstructive pulmonary disease who developed severe dyspnoea at home, and a case of an 81-year-old woman who had an allergic reaction associated with severe dyspnoea. The paramedics accidentally administered racemic adrenaline intravenously in both cases. Both patients suffered from severe cardiac adverse effects but their outcome was eventually favourable. Previous reports of accidental intravenous administration of racemic adrenaline are also reviewed. We discuss the potential risks of using racemic adrenaline, especially in the treatment of geriatric patients, and the possibilities of reducing the risk of accidents in drug administration.

Accidental Intravenous Administration of Magnesium Sulfate during Cesarean Section: A case report

We report a case of the accidental intravenous administration of a large dose of magnesium sulfate during cesarean section. A 41-year-old woman, at 33 weeks gestation, with pregnancy-aggravated hypertension, headache and generalized edema presented in acute labor and showed fetal bradycardia on a nonstress test. Laboratory tests demonstrated an increased level of magnesium (5.4 mg/dl). A cesarean section was performed under general anesthesia with -enflurane and vecuronium. After delivery 2,000 mg of magnesium sulfate was mixed with the lactated Ringer's solution 1,000 ml and 550 ml administered to the patient. After noticing the accidental infusion of the magnesium sulfate, we replaced the lactated Ringer's solution with normal saline 1,000 ml and performed arterial blood gas analysis, checked serum electrolyte, including and , and had monitored depth of muscle relaxation and vital signs. The level of magnesium had increased to 8.9 mg/dl after the accidental magnesium infusion. For about one and half hours after emergence from general anesthesia, she complained of dyspnea and paraparesis of extremities. To treat the hypermagnesemia, 3% calcium gluconate 1,000 mg and furocemide were given intravenously to antagonize magnesium and to increase the urine output. The depth of neuromuscular block was frequently monitored using a nerve stimulator. After conservative treatment, she recovered from the effect of the hypermagnesemia and was discharged on the fifth postoperative day. Anesthesiologists must to keep in mind the preoperative patients' pathophysiologic conditions, check co-administered drugs and the contents of intravenously connected solutions.

The Dangers of Trying to Make Ends Meet: Accidental Intravenous Administration of Enteral Feed

We report a case of inadvertent intravenous administration of enteral feed, a very rare but potentially life-threatening complication of enteral feeding. Bacterial contamination of feed results in a severe septic response that requires broad-spectrum antibiotic cover and aggressive organ support. The failure of measures aimed at prevention of this complication must be investigated, and practice changed to ensure that further incidents are avoided.

Local and Regional Anesthesia

Local anesthetics have the unique ability to produce complete blockade of sensory nerve fibers and prevent or pre-empt the development of secondary (central) sensitization to pain. For this reason, local and regional anesthetic techniques are often used with opioids, alpha 2-receptor agonists, dissociatives, and anti-inflammatory drugs as part of a multimodal strategy to manage pain. Lidocaine and bupivacaine are the local anesthetics used most commonly in dogs and cats. Lidocaine has a fast onset (10-15 min) and an intermediate duration of action (60-120 min), and is used for short diagnostic and surgical procedures. Bupivacaine has a slow onset (20-30 min) and a long duration of action (240-360 min), and is used to control pain both preoperatively and postoperatively. Local anesthetics are relatively safe if they are administered correctly. Administration of an excessive dose and accidental intravenous administration are probably the most common causes of systemic toxicity in small animals. Doses of local anesthetics, especially those for cats and small dogs, should always be calculated carefully. In many animals, the most simple and elegant way to control pain perioperatively is to perform a local or regional anesthetic block. Veterinarians should not hesitate to incorporate local and regional anesthetic techniques into their pain management strategies for dogs and cats.

Zuclopenthixol acetate (Clopixol Acuphase) for rapid sedation

This case report documents the effects of accidental intravenous administration of zuclopenthixol acetate and briefly discusses its appropriate use in the management of psychiatric emergencies.

Accidental intravenous administration of enteral feeds by a patient with cystic fibrosis

Young adults with cystic fibrosis are actively encouraged to take increasing self-responsibility, both at home and in hospital, for their often complicated therapeutic regimens. Many patients manage both their intravenous antibiotics and overnight enteral feeds. In our unit strict training protocols are followed to ensure that patients fully understand, and can safely perform, any procedure for which they will subsequently be responsible. Nonetheless, a 21-year-old man with cystic fibrosis admitted for treatment of his acute respiratory deterioration inadvertently attached his disconnected nasogastric feeding line to his intravenous access site during the night. Approximately 500 ml of enteral feed was administered intravenously with subsequent fevers, rigors, tachycardia, and vomiting. This is the first report of the patient, rather then the medical staff, inadvertently connecting the enteral feeding line to the intravenous access site.

Hypoxaemia and hypotension after intravenous codeine phosphate

This report describes a case of accidental intravenous administration of codeine phosphate (1 mg.kg-1) to a previously healthy five-year-old boy, who was undergoing strabismus surgery. Hypoxaemia (SpO2 85% with FIO2 of 1) and hypotension (systolic BP 65 mmHg) resulted, which responded to resuscitation with lactated Ringers' (20 ml.kg-1) and phenylephrine (2 micrograms.kg-1). The degree of hypoxaemia observed in this case was severe, but was not associated with clinical evidence of bronchospasm. Possible mechanisms for this reaction might have included direct myocardial depression and histamine release. This case adds further support to the recommendation that codeine phosphate should never be administered intravenously.