JobsFan

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Do you guys have special connectors on epidural catheters designed to stop people injecting the wrong syringe down an epidural?

there is some talk of adopting them here.
currently we just use the standard luer lock, IV connector.
 

pgg

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Everywhere I've ever been our epidural connectors have been bright yellow with a bright yellow filter and a bright yellow sticker that says EPIDURAL CATHETER on it.

I'd hate to have to chase down a special syringe every time I wanted to bolus a catheter. Ain't nobody got time for that.
 
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our filters are white - come with yellow epidural stickers
 

urge

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Do you guys have special connectors on epidural catheters designed to stop people injecting the wrong syringe down an epidural?

there is some talk of adopting them here.
currently we just use the standard luer lock, IV connector.
What kind of stuff has been injected trough the epidural catheter at your place?

:corny:
 
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dragonark

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What kind of stuff has been injected trough the epidural catheter at your place?

:corny:
a phenylephrine bag was once hung instead of the standard local fent infusion...that nurse was fired...but only because she lied and tried to cover it up
 

anes121508

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Popsicle stick with tape like an arm board to make it a pain in the rear to take apart...not lying that's what our place does
 

Mman

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Do you guys have special connectors on epidural catheters designed to stop people injecting the wrong syringe down an epidural?

there is some talk of adopting them here.
currently we just use the standard luer lock, IV connector.
I think nearly everywhere uses a regular luer lock. I can't imagine the fun if you had a stat c-section and were trying to bolus a catheter but couldn't find the super special syringe that fits the connector.

But yes, there are case reports of almost any IV med you can imagine going in the epidural.
 
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JobsFan

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What kind of stuff has been injected trough the epidural catheter at your place?

:corny:
not so much "my place" -- likely to be a nation-wide standard, in response to ongoing (but infrequent) syringe swap errors with pretty much anything.
 

pgg

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Great

One more necessary specialty item to be not stocked in the cart when I need it.

We'll need a separate incompatible connector for a-line tubing, too.

Actually, giving epidural-sized doses through an intrathecal catheter that was believed to be an epidural is probably a bigger risk than a wrong-drug error. So we need another special connector to prevent epidural/intrathecal mix ups.

So that's four incompatible systems, to start.

It's like Catbert is running hospitals these days.
 
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Great

One more necessary specialty item to be not stocked in the cart when I need it.

We'll need a separate incompatible connector for a-line tubing, too.

Actually, giving epidural-sized doses through an intrathecal catheter that was believed to be an epidural is probably a bigger risk than a wrong-drug error. So we need another special connector to prevent epidural/intrathecal mix ups.

So that's four incompatible systems, to start.

It's like Catbert is running hospitals these days.
I don't disagree, but I think it's a good idea to acknowledge the risk, and try to mitigate it.
We use red syringes for muscle relaxants, I'd be happy with yellow connectors and yellow syringes for local anaesthetics.
 

urge

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I don't disagree, but I think it's a good idea to acknowledge the risk, and try to mitigate it.
We use red syringes for muscle relaxants, I'd be happy with yellow connectors and yellow syringes for local anaesthetics.
Do you mean red syringe or a red sticker on a regular syringe?
 

Mman

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I don't disagree, but I think it's a good idea to acknowledge the risk, and try to mitigate it.
We use red syringes for muscle relaxants, I'd be happy with yellow connectors and yellow syringes for local anaesthetics.
you have colored syringes? WTF?
 
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yes - a 5mL red syringe.

The Time for Change proposal, prepared by the Western Health Pharmacy Department (Victoria, Australia) in consultation with their Anaesthetic Department, outlines possible changes to the packaging of muscle relaxants.


http://ezdrugid.org/strategies.html

e.g.
January
Better labelling to reduce the chance of awake paralysis

  • The College and Association’s fifth National Audit Project reported 17 cases of ‘drug errors and awake paralysis’, with 11 of these due to syringe swaps.
  • Australian data suggests that the most common reported ‘wrong drug’ error was actually giving the wrong drug from a correctly labelled syringe, known as a syringe swap.
  • SALG advocates that anaesthetists use the International Colour Coding System for user-applied syringe labels, but currently there is no other way to distinguish between syringes. Could we do more to identify neuromuscular blocking agents after they have been drawn up?
Responding to a pair of incidents where a muscle relaxant was given instead of midazolam, Rachel Williams and Helen Bromhead from Hampshire Hospitals Foundation Trust wanted to do more to differentiate syringes containing neuromuscular blocking agents (NMB) from other drugs.

Using 'Red-Plunger' syringes for muscle relaxants is standard practice in Australia and New Zealand. Using a different syringe colour, rather than just a sticker, has been part of approaches used to reduce the chance of mixing up syringes intended for neuraxial, enteral and intravenous/ intramuscular/subcutaneous use.

Williams and Bromhead found it hard to source alternatively coloured syringes, so instead they designed and adopted colour-coded stickers to apply to the plunger of the syringe in an attempt to replicate a red plunger syringe.

They suggest that this makes the NMB syringe instantly recognisable and clearly differentiates it from other syringes of the same size containing colourless fluid.

This project was featured at the Safe Anaesthesia Liaison Group Patient Safety Conference 2015.



 
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Mman

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uhh

so now you need an anesthesia cart not only stocked with various sizes of syringes, but with multiple colors of each size????
 

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uhh

so now you need an anesthesia cart not only stocked with various sizes of syringes, but with multiple colors of each size????
Patient safety though
Color coding syringes eliminates all medication errors obviously.
 
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Mman

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Patient safety though
Color coding syringes eliminates all medication errors obviously.
I'm curious if there is any objective data about the overall incidence of a syringe swap with an NMB causing harm to patient. I mean what are the actual odds? Since I've been at my job, we've probably done about 400,000 anesthetics (give or take) and have not had such an incident. Are we just super vigilant? Not any more so than other places.

The harms to patient we've had in our buildings with NMBs have all been people giving them inappropriately but intentionally and a syringe color would not have helped.
 
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JobsFan

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uhh

so now you need an anesthesia cart not only stocked with various sizes of syringes, but with multiple colors of each size????
yes - it's a major inconvenience to have a tray of red syringes near by.
 

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What's the incidence of accidentally putting a paralytic drug in a clear syringe when there are red syringes nearby? Are you adding complexity to turn one exceedingly rare event into a different kind of exceedingly rare event?

Prefilled syringes aren't a bad idea.

I've become a fan of the Codonics label makers. Grab a vial, hold it under the scanner, and it speaks the drug name and spits out a colored label (including date/time and your name to keep JC extra happy).
 

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I've become a fan of the Codonics label makers. Grab a vial, hold it under the scanner, and it speaks the drug name and spits out a colored label (including date/time and your name to keep JC extra happy).
Does your hospital have money for that?
 

pgg

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Does your hospital have money for that?
Apparently so. They're in some ORs, not all of them. Now I'm spoiled, and when I draw an OR without one my first thought of the day is "aw ****" ...

The hospital I'm going back to next year is looking at getting them as an add-on to the Omnicells that will be installed in each room.

I think they're a couple thousand $ per unit. Plus ink and label costs. And surely a service contract. Pretty expensive for an inkjet label printer.

They're nice. Whether they're worth the cost in return for maybe reducing drug errors a teeny tiny amount, and for satisfying JC/CMS, and saving a few minutes of case setup time ... whole different conversation.


Engineering/system controls for safety are the best kind of controls, and the Codonics thing works. I cited it as a contrast to this red syringe idea (which I suspect doesn't really reduce the kind of errors it's supposed to) and the non-Luer connector issue which introduces practical headaches.
 

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Color coding -- what about the nontrivial % of (male) colorblind physicians?
 
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syringes also have the letters 'D A N G E R' embossed into the plunger in Braille and a skull and crossbones on end of plunger to denote neuromuscular blockers.
 

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yes - it's a major inconvenience to have a tray of red syringes near by.
The problem is that these things encourage people to not read the label. I guarantee that this will just introduce a new set of errors. Someone somewhere will fill a red syringe with something thats not a muscle relaxant. Like epi. And someone else will grab it and push it without looking at the label thinking red means relaxant. Or someone will put relaxant in an orange syringe, and someone will push it thinking orange means versed, without reading the succ label on the syringe.
 
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