CRNA horror stories

[kazuma]

A resident in the class ahead of me inadvertently gave 10mg phenylephrine to an elective C/S pt in preop thinking it was famotidine. She said she felt strange which made he/she realize they had an empty vial of Phenylephrine in their hand. I can't remember the outcome, but her BP when they got to the OR wasn't as high as you would have thought, maybe 220-230 systolic, can't remember the HR. I think baby and mom ended up being ok but that's going to be a long 18 years for my former colleague. That was a very uncomfortable M&M.

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[dhb]

A resident in the class ahead of me inadvertently gave 10mg phenylephrine to an elective C/S pt in preop thinking it was famotidine. She said she felt strange which made he/she realize they had an empty vial of Phenylephrine in their hand. I can't remember the outcome, but her BP when they got to the OR wasn't as high as you would have thought, maybe 220-230 systolic, can't remember the HR. I think baby and mom ended up being ok but that's going to be a long 18 years for my former colleague. That was a very uncomfortable M&M.

I don't think you can go any higher than 250 systolic and don't you reach those numbers when you exercise?

 

[WholeLottaGame7]

I don't think you can go any higher than 250 systolic and don't you reach those numbers when you exercise?

I saw low 300s in a crani case when the neurosurgery resident must have injected the 30cc syringe of dilute epi straight into a scalp vein. Pro tip: labetalol seemed to work best; 400 of prop, 250 of fent, and 5% iso did nothing. Thankfully it was a tumor case and not an aneurysm.

Getting the thread back on track: as we can see, everyone makes mistakes. The trick is to identify them, admit them, and ask for help. And for residents soon to be moving into a supervisory role, learning to anticipate and trouble-shoot other people's mistakes. I've been amazed by the number of creative ways people can (usually unintentionally, in my case) sabotage you. And it's not always that people won't call you, it's that they're going to call you too late.

I can usually think of at least once or twice per week where I walk in on a kid laryngospasming or someone changing BP cuff size/location for a legit hypotension before I was called. Sometimes it's just luck, and sometimes it's "acquired" luck, from learning when to check in on cases or habitually stalking intra-op Epic records while doing charting/orders/pre-ops.

 

[criticalelement]

A resident in the class ahead of me inadvertently gave 10mg phenylephrine to an elective C/S pt in preop thinking it was famotidine. She said she felt strange which made he/she realize they had an empty vial of Phenylephrine in their hand. I can't remember the outcome, but her BP when they got to the OR wasn't as high as you would have thought, maybe 220-230 systolic, can't remember the HR. I think baby and mom ended up being ok but that's going to be a long 18 years for my former colleague. That was a very uncomfortable M&M.

10 mg of neo IV is capable of causing a stroke

 

[pgg]

I don't think you can go any higher than 250 systolic

Why do you say that?

and don't you reach those numbers when you exercise?

Sure ...

 

[kazuma]

10 mg of neo IV is capable of causing a stroke

I totally agree. My point was that I'm surprised she didn't have any noticeable problems.

 

[Arch Guillotti]

I don't think you can go any higher than 250 systolic and don't you reach those numbers when you exercise?

What are you basing this on?

 

[deleted547339]

I don't think you can go any higher than 250 systolic and don't you reach those numbers when you exercise?

Come to my ER. I see SBPs in that ballpark at least once a day. And I'm not talking in hemorrhage stroke patients, I'm talking about my 50y/o diabetic smokers with CHF, ESRD on HD who like cocaine.

 

[NPOpMN]

University of Colorado at Denver - 2015 - a CRNA used bupivicaine instead of dilute lidocaine for a Bier Block.

 

[PainDrain]

I did a pheo where the BP reading on our A-line was maxed at 320 systolic, which was the highest our monitor showed. Surgeon kept squeezing the tumor. I was expecting a stroke but you can't kill this type of patient if you know what I mean.

 

[dhb]

Why do you say that?.

Well to have a pressure you need a force against a resistance and since they can't be infinite there a limit to BP. I've never seen more than 260 so that was my assumption but maybe you can rarely get up to 300 as the other poster has alluded

 

[projectpat]

University of Colorado at Denver - 2015 - a CRNA used bupivicaine instead of dilute lidocaine for a Bier Block.

CRNAs do bier blocks? especially at the University? maybe in BumbleFu I get it..

 

[deleted162650]

What? She just wanted it to last longer OK.

 

[ZzzPlz]

What? She just wanted it to last longer OK.

Plus asystole=less blood loss=no required tourniquets=no tourniquet pain.

She may be on to something.

 

[deleted162650]

OK so yesterday one of my partners shared what is perhaps the king of all F-up stories. This happened during his cardiac fellowship at a well known program in the South:

CRNA doing a belly case. Attending surgeon and resident scrubbed in. Surgeon happens to have the flu, and feels crappier as the case progresses to the point where he decides to scrub out. He comes around to the head of the bed and asks the CRNA to start an IV so he can get hydrated up which she does. He takes a seat up by the head where he can continue supervising his resident. After a while the surgery resident asks for more relaxation, so the CRNA pushes 50mg of Roc. A few seconds later the attending surgeon says "Man, my IV is stinging." With that, the CRNA immediately realizes what she has done. . .and promptly freaks the F out. She grabs the surgeons IV and yanks it out of his arm in a futile attempt to prevent the Roc from flushing in. Needless to say, too little too late. Surgeon slumps to the floor and with his last breath manages to eek out "I Just ate a turkey sandwi. . ." Apparenly now he's concerned about the NPO guidelines. My partner goes into the room upon hearing the overhead "Anesthesia STAT" call for the 4th time. He walks in to find someone trying to bag the surgeon while the CRNA is flailing with an 18g desperately trying to restart an IV after yanking out the one she had. Surgeon ends up getting intubated without any sedation which he later says was the worst/most painful experience of his life. After some time in PACU, the surgeon gets extubated and does fine. The CRNA ultimately resigned.

 

[urge]

OK so yesterday one of my partners shared what is perhaps the king of all F-up stories. This happened during his cardiac fellowship at a well known program in the South:

CRNA doing a belly case. Attending surgeon and resident scrubbed in. Surgeon happens to have the flu, and feels crappier as the case progresses to the point where he decides to scrub out. He comes around to the head of the bed and asks the CRNA to start an IV so he can get hydrated up which she does. He takes a seat up by the head where he can continue supervising his resident. After a while the surgery resident asks for more relaxation, so the CRNA pushes 50mg of Roc. A few seconds later the attending surgeon says "Man, my IV is stinging." With that, the CRNA immediately realizes what she has done. . .and promptly freaks the F out. She grabs the surgeons IV and yanks it out of his arm in a futile attempt to prevent the Roc from flushing in. Needless to say, too little too late. Surgeon slumps to the floor and with his last breath manages to eek out "I Just ate a turkey sandwi. . ." Apparenly now he's concerned about the NPO guidelines. My partner goes into the room upon hearing the overhead "Anesthesia STAT" call for the 4th time. He walks in to find someone trying to bag the surgeon while the CRNA is flailing with an 18g desperately trying to restart an IV after yanking out the one she had. Surgeon ends up getting intubated without any sedation which he later says was the worst/most painful experience of his life. After some time in PACU, the surgeon gets extubated and does fine. The CRNA ultimately resigned.

Unbelievable on multiple levels.

1 The surgeon should have cancelled the case or asked for a co surgeon to take over.

2 An iv should not have been placed in the OR.

3 CRNA mistaking one line for another. Why was he standing next to the CRNA instead of his resident? Is the surgeon now at risk of contamination from the patient from a re used Roc/Vec syringe?

4 Yanking out the IV.

5 Intubation with no sedation despite the surgeon already being bagged? Why not just continue bagging him until an iv is secured and then worrying about the intubation?

I think the surgeon should probably get in trouble too.

 

[urge]

I don't think you can go any higher than 250 systolic

Yes, you can. A lot higher. 250 systolic is child's play.

I cannot disclose how I know. But, it wasn't pretty.

 

[urge]

I can usually think of at least once or twice per week where I walk in on a kid laryngospasming or someone changing BP cuff size/location for a legit hypotension before I was called.

You need a new job.

 

[urge]

I can't imagine anything beyond 2:1 to remotely satisfy the concept of proper supervision for most procedures. If I were a malpractice lawyer, I would start by having the defending anesthesiologist demonstrate how they could properly supervise, based on the day's schedule. Most often than not, it will prove that the CRNAs were completely unsupervised at least 50% of the time, because the attending was doing something else than watching them.

You can, but you cannot be doing the preops yourself. Meet the patient in the OR. Going from OR to OR after another. Breaks are out of the question.

I charge 5k a day if interested.

 

[urge]

You want to insure someone doesn't call? Make them feel stupid and they won't next time.

Words of wisdom.

 

[jwk]

CRNAs do bier blocks? especially at the University? maybe in BumbleFu I get it..

Seriously?

 

[urge]

Those vials scare me a bit. I have a very specific method for drawing up the neo (I draw it up into a 3cc syringe clearly labeled, and our drawers have a divider in them. I keep my stock neo in the drawer with the pre-packaged flush. It is the only non-flush syringe I keep there. And I draw up the neo before the case (apparently some folks don't?) and I do not put it into a flush syringe. One of my classmates diluted it like that, went on a break and came back to the break person working hard to correct HTN and no "flush."

Very hard to follow you.

 

[Laryngophed]

Very hard to follow you.

Sorry, I was having a moment. Or several moments all strung together.

I draw up the 10mg/mL neo into a 3 cc syringe. The only other drug I routinely draw up in a 3 cc syringe is ondansetron. Both are labeled. I use multiple "checks" to make sure I'm giving the appropriate med. After labeling, the volume in the syringe is another check I use to ensure I'm giving the med I think I'm giving (in addition to being clearly labeled), i.e. ondansetron is 2cc of 2mg/mL at our place and phenylephrine is 1cc of 10mg/mL. I also keep them in separate spaces (the stock neo in one place, the zofran in another) so that if someone were to give me a break they would have to actively work hard to mistakenly given 9mg of neo. I also do not dilute my neo for the case into the 10cc premade flushes. I get a plain 10cc syringe, get 10cc of saline from the bag and add the 0.1cc of the stock to make my 100mcg/mL neo for the case. A classmate of mine put the 0.1cc into a premade flush (and labeled it!) but while they were on a break someone grabbed the flush stick with neo and gave the whole thing because they thought it was a premade flush and not the neo.

 

[jwk]

Those vials scare me a bit. I have a very specific method for drawing up the neo (I draw it up into a 3cc syringe clearly labeled, and our drawers have a divider in them. I keep my stock neo in the drawer with the pre-packaged flush. It is the only non-flush syringe I keep there. And I draw up the neo before the case (apparently some folks don't?) and I do not put it into a flush syringe. One of my classmates diluted it like that, went on a break and came back to the break person working hard to correct HTN and no "flush."

OK, just saw your follow up post. There is ZERO reason to draw up undiluted phenylephrine and leave it in a drawer. That's just inviting disaster. I hope it's at least labeled phenylephrine and not just "neo". Draw it up, do your dilution, toss the rest. We used to do a double-dilution till we got pre-fills, which are the best solution. Draw up the 10mg of phenylephrine, draw up 9cc of NS, agitate, squirt out all but 1cc, then draw up another 9cc of NS, and you have your final dilution of 100mcg/cc.

 

[Random Anesthesiologist]

Things never to draw up until you need them: Undilute purple drugs (well Undilute anything), protamine

And I always keep dangerous drugs in a place I can't easily grab them.

 

[Doctor4Life1769]

Sorry, I was having a moment. Or several moments all strung together.

I draw up the 10mg/mL neo into a 3 cc syringe. The only other drug I routinely draw up in a 3 cc syringe is ondansetron. Both are labeled. I use multiple "checks" to make sure I'm giving the appropriate med. After labeling, the volume in the syringe is another check I use to ensure I'm giving the med I think I'm giving (in addition to being clearly labeled), i.e. ondansetron is 2cc of 2mg/mL at our place and phenylephrine is 1cc of 10mg/mL. I also keep them in separate spaces (the stock neo in one place, the zofran in another) so that if someone were to give me a break they would have to actively work hard to mistakenly given 9mg of neo. I also do not dilute my neo for the case into the 10cc premade flushes. I get a plain 10cc syringe, get 10cc of saline from the bag and add the 0.1cc of the stock to make my 100mcg/mL neo for the case. A classmate of mine put the 0.1cc into a premade flush (and labeled it!) but while they were on a break someone grabbed the flush stick with neo and gave the whole thing because they thought it was a premade flush and not the neo.

Why are you drawing up phenylephrine in a 3cc syringe anyway
I don't understand the need for folks to drop up random drugs in a syringe or injecting drugs into a saline vial and just have them vaguely labeled or otherwise.

 

[Laryngophed]

Why are you drawing up phenylephrine in a 3cc syringe anyway
I don't understand the need for folks to drop up random drugs in a syringe or injecting drugs into a saline vial and just have them vaguely labeled or otherwise.

I draw the stock 10mg/mL into a 3cc vial for diluting into 100mcg/mL. And rather than mess with the inevitable bubbles in a 1cc syringe, I just draw it into a 3cc.

 

[Doctor4Life1769]

I draw the stock 10mg/mL into a 3cc vial for diluting into 100mcg/mL. And rather than mess with the inevitable bubbles in a 1cc syringe, I just draw it into a 3cc.

I used to dilute the stock into a 100cc or 250cc NS bag, mix, and then draw up the diluted phenylephrine into 10cc syringes to have avail. All this involved the use of 1 syringe, the 10cc one. Syringes and bag were properly labeled. Bag was essentially able to be used as a gtt if ever needed.

Of course, by the time I left, they finally had 10cc syringes of prefilled diluted phenylephrine.

 

[rockchalkjdoc]

Things never to draw up until you need them: Undilute purple drugs (well Undilute anything), protamine

And I always keep dangerous drugs in a place I can't easily grab them.

I'd add pitocin during CS to this list. When I was a student a resident told a horror story about pitocin started before baby was out, and I'm too risk averse to take chances with an 18 year statute of limitations

 

[nimbus]

I did a pheo where the BP reading on our A-line was maxed at 320 systolic, which was the highest our monitor showed. Surgeon kept squeezing the tumor. I was expecting a stroke but you can't kill this type of patient if you know what I mean.

Maybe we had the same surgeon. I was giving 10ml blouses of nitroprusside.

 

[Doctor4Life1769]

I'd add pitocin during CS to this list. When I was a student a resident told a horror story about pitocin started before baby was out, and I'm too risk averse to take chances with an 18 year statute of limitations

There was someone who almost gave it in stock form directly IV without dilution, but was caught prior to such act

 

[Random Anesthesiologist]

I'd add pitocin during CS to this list. When I was a student a resident told a horror story about pitocin started before baby was out, and I'm too risk averse to take chances with an 18 year statute of limitations

Good call.

 

[San Marzano]

OK so yesterday one of my partners shared what is perhaps the king of all F-up stories. This happened during his cardiac fellowship at a well known program in the South:

CRNA doing a belly case. Attending surgeon and resident scrubbed in. Surgeon happens to have the flu, and feels crappier as the case progresses to the point where he decides to scrub out. He comes around to the head of the bed and asks the CRNA to start an IV so he can get hydrated up which she does. He takes a seat up by the head where he can continue supervising his resident. After a while the surgery resident asks for more relaxation, so the CRNA pushes 50mg of Roc. A few seconds later the attending surgeon says "Man, my IV is stinging." With that, the CRNA immediately realizes what she has done. . .and promptly freaks the F out. She grabs the surgeons IV and yanks it out of his arm in a futile attempt to prevent the Roc from flushing in. Needless to say, too little too late. Surgeon slumps to the floor and with his last breath manages to eek out "I Just ate a turkey sandwi. . ." Apparenly now he's concerned about the NPO guidelines. My partner goes into the room upon hearing the overhead "Anesthesia STAT" call for the 4th time. He walks in to find someone trying to bag the surgeon while the CRNA is flailing with an 18g desperately trying to restart an IV after yanking out the one she had. Surgeon ends up getting intubated without any sedation which he later says was the worst/most painful experience of his life. After some time in PACU, the surgeon gets extubated and does fine. The CRNA ultimately resigned.

I just had to sign in and quote this because it's by far the most outrageous story I have ever heard from an operating room. If you have one that is more outrageous, please post it so that I can read it and be in awe of its outrageousness.

 

[jwk]

I draw the stock 10mg/mL into a 3cc vial for diluting into 100mcg/mL. And rather than mess with the inevitable bubbles in a 1cc syringe, I just draw it into a 3cc.

Am I missing something? You're still drawing up the 10mg/ml and leaving it, undiluted, in the syringe in your drawer. If that's correct, again, that's just asking for trouble.

 

[Doctor4Life1769]

Am I missing something? You're still drawing up the 10mg/ml and leaving it, undiluted, in the syringe in your drawer. If that's correct, again, that's just asking for trouble.

I was confused about it too. Either way, sounds like too many unnecessary steps.

 

[urge]

Sorry, I was having a moment. Or several moments all strung together.

I draw up the 10mg/mL neo into a 3 cc syringe. The only other drug I routinely draw up in a 3 cc syringe is ondansetron. Both are labeled. I use multiple "checks" to make sure I'm giving the appropriate med. After labeling, the volume in the syringe is another check I use to ensure I'm giving the med I think I'm giving (in addition to being clearly labeled), i.e. ondansetron is 2cc of 2mg/mL at our place and phenylephrine is 1cc of 10mg/mL. I also keep them in separate spaces (the stock neo in one place, the zofran in another) so that if someone were to give me a break they would have to actively work hard to mistakenly given 9mg of neo. I also do not dilute my neo for the case into the 10cc premade flushes. I get a plain 10cc syringe, get 10cc of saline from the bag and add the 0.1cc of the stock to make my 100mcg/mL neo for the case. A classmate of mine put the 0.1cc into a premade flush (and labeled it!) but while they were on a break someone grabbed the flush stick with neo and gave the whole thing because they thought it was a premade flush and not the neo.

1 Isn't setup standard in you residency? Having people come in and go during a case with non standard setup is asking for trouble overall.

2 What's the purpose of the pre made flush syringes during a case? Don't they have a working IV line already? Those flush syringes come in handy to start IVs with hep locks but that is about it.

 

[deleted162650]

I used to dilute the stock into a 100cc or 250cc NS bag, mix, and then draw up the diluted phenylephrine into 10cc syringes to have avail. All this involved the use of 1 syringe, the 10cc one. Syringes and bag were properly labeled. Bag was essentially able to be used as a gtt if ever needed.

Of course, by the time I left, they finally had 10cc syringes of prefilled diluted phenylephrine.

Yes, this is what normal humans do.

 

[Ronin786]

It shouldn't be this difficult.

Premade dilute phenylephrine syringes or squirt the 10mg/ml into a 250cc bag. Label it properly, put it behind the anesthesia machine and draw up as needed. Our standard dilution is 40mcg/cc.

 

[btbam]

I just had to sign in and quote this because it's by far the most outrageous story I have ever heard from an operating room. If you have one that is more outrageous, please post it so that I can read it and be in awe of its outrageousness.

I work at a hospital in the same system as said story and yes it is true, except the surgeon was supposedly insisting on continuing to operate with an IV and had his fluids right next to the patients on the pole. Needless to say a complete **** up on all levels. The hospital had to institute a policy that the patient could be the only one in the OR with IV fluids, you can't make this stuff up.

 

[Random Anesthesiologist]

It shouldn't be this difficult.

Premade dilute phenylephrine syringes or squirt the 10mg/ml into a 250cc bag. Label it properly, put it behind the anesthesia machine and draw up as needed. Our standard dilution is 40mcg/cc.

Ours is 80mcg/mL

 

[Random Anesthesiologist]

I work at a hospital in the same system as said story and yes it is true, except the surgeon was supposedly insisting on continuing to operate with an IV and had his fluids right next to the patients on the pole. Needless to say a complete **** up on all levels. The hospital had to institute a policy that the patient could be the only one in the OR with IV fluids, you can't make this stuff up.

And no one thought to put labels to differentiate which IV is which? Anesthesia is hard.

 

[Doctor4Life1769]

To be honest, the surgeon should have had his own damn IV pole and shouldn't have attached his IV bag to the patient's on the same pole. That's just a recipe for disaster. Yes, the CRNA should have made labels and yes he/she should have followed the line to the patient before injecting (50mg roc intraop? Hope it was a long-ass case) into the line.

 

[criticalelement]

To be honest, the surgeon should have had his own damn IV pole and shouldn't have attached his IV bag to the patient's on the same pole. That's just a recipe for disaster. Yes, the CRNA should have made labels and yes he/she should have followed the line to the patient before injecting (50mg roc intraop? Hope it was a long-ass case) into the line.

Maybe it was an intentional injection... maybe she secretly hated the surgeon

 

[ZzzPlz]

Maybe it was an intentional injection... maybe she secretly hated the surgeon

Yeah he probably kept asking for more relaxation

 

[Laryngophed]

OK, just saw your follow up post. There is ZERO reason to draw up undiluted phenylephrine and leave it in a drawer. That's just inviting disaster. I hope it's at least labeled phenylephrine and not just "neo". Draw it up, do your dilution, toss the rest. We used to do a double-dilution till we got pre-fills, which are the best solution. Draw up the 10mg of phenylephrine, draw up 9cc of NS, agitate, squirt out all but 1cc, then draw up another 9cc of NS, and you have your final dilution of 100mcg/cc.

It is labeled as phenylephrine with concentration, date, and time on it. FWIW, I label everything, and I wrote the concentration on every single syringe I use and don't immediately dispose of. And it is kept separate from every other drug in my cart. And I tell the folks that give me breaks and relieve me.

I have thought about, but have elected not to make a bag of phenylephrine for using in all cases but that's a different discussion. I would prefer the premise Neosynephrine syringes, but I'm not on P&T at my place so I don't know why it hasn't happened.

 

[vector2]

It is labeled as phenylephrine with concentration, date, and time on it. FWIW, I label everything, and I wrote the concentration on every single syringe I use and don't immediately dispose of. And it is kept separate from every other drug in my cart. And I tell the folks that give me breaks and relieve me.

I have thought about, but have elected not to make a bag of phenylephrine for using in all cases but that's a different discussion. I would prefer the premise Neosynephrine syringes, but I'm not on P&T at my place so I don't know why it hasn't happened.

Care to share your thought process on why you wouldn't just squirt 1cc of phenylephrine into a 100cc bag and draw up the dilute sticks you think you'd need for your cases that day? Precise labeling and good handoff report is certainly a safeguard, but the only way to prevent wrong syringe errors is to not have abnormal/high concentration syringes even present in the room. If you insist on making your strange 3cc phenylephrine syringe, I'd suggest keeping it on your person at all times, especially if you do any peds cases.

 

[Doctor4Life1769]

It is labeled as phenylephrine with concentration, date, and time on it. FWIW, I label everything, and I wrote the concentration on every single syringe I use and don't immediately dispose of. And it is kept separate from every other drug in my cart. And I tell the folks that give me breaks and relieve me.

I have thought about, but have elected not to make a bag of phenylephrine for using in all cases but that's a different discussion. I would prefer the premise Neosynephrine syringes, but I'm not on P&T at my place so I don't know why it hasn't happened.

I'm not sure how that is a different discussion.
So, you draw up a stock solution in a 3cc syringe and dilute for each case?
You see how easier and safer it is to have a bag to use for each case?

 

[Laryngophed]

I'm not sure how that is a different discussion.
So, you draw up a stock solution in a 3cc syringe and dilute for each case?
You see how easier and safer it is to have a bag to use for each case?

Sorry, I thought you meant to make one bag up for the day. My objection to drawing up 1 vial of 10mg/mL and making 1 100cc bag for the day and then using it for every patient is very simply that I don't know how to assign that in terms of charge for the patient. If I do that before first starts and then used the bag to make a stock and then used new, fresh syringe from that each day, I wouldn't know how to charge any patient. So I'd have to make a new bag each case. I could easily make the bags for each case, but that is another charge as well for the patient. Certainly one to consider. Thankfully with good labeling, handoffs, and physical separation of the drug from the other syringes (I also lay out all the drugs I'm going to use for case --- with protamine being the exception. I don't draw that up until we're rewarming) I've never had an issue. That said, I'm not opposed to making a bag for each case. As was suggested above, one bag for the day would make me uncomfortable.

 

[Doctor4Life1769]

Sorry, I thought you meant to make one bag up for the day. My objection to drawing up 1 vial of 10mg/mL and making 1 100cc bag for the day and then using it for every patient is very simply that I don't know how to assign that in terms of charge for the patient. If I do that before first starts and then used the bag to make a stock and then used new, fresh syringe from that each day, I wouldn't know how to charge any patient. So I'd have to make a new bag each case. I could easily make the bags for each case, but that is another charge as well for the patient. Certainly one to consider. Thankfully with good labeling, handoffs, and physical separation of the drug from the other syringes (I also lay out all the drugs I'm going to use for case --- with protamine being the exception. I don't draw that up until we're rewarming) I've never had an issue. That said, I'm not opposed to making a bag for each case. As was suggested above, one bag for the day would make me uncomfortable.

.

 

[urge]

Sorry, I thought you meant to make one bag up for the day. My objection to drawing up 1 vial of 10mg/mL and making 1 100cc bag for the day and then using it for every patient is very simply that I don't know how to assign that in terms of charge for the patient. If I do that before first starts and then used the bag to make a stock and then used new, fresh syringe from that each day, I wouldn't know how to charge any patient. So I'd have to make a new bag each case. I could easily make the bags for each case, but that is another charge as well for the patient. Certainly one to consider. Thankfully with good labeling, handoffs, and physical separation of the drug from the other syringes (I also lay out all the drugs I'm going to use for case --- with protamine being the exception. I don't draw that up until we're rewarming) I've never had an issue. That said, I'm not opposed to making a bag for each case. As was suggested above, one bag for the day would make me uncomfortable.

How is your method of a 3cc syringe different than the bag, in terms of cost? You would still need one vial of phenyleprine per patient?

You are talking about savings cents on a bag compared to a 3cc syringe and a 1cc syringe vs spending tens of thousands or more per drug mistake.

You are worried for less than one dollar per patient.

Do you realize that you waste more than that on tegaderms? Never mind stuff like a Bis sticker.