In our recent three-part series on Infections in the ICU, we focused on device-assisted infections. Today, we’ll investigate the hazards involved with anesthetic residues in IV lines in the ICU.
In 2002, the World Health Organization reported that, of the 35 million healthcare workers across the globe, 2 million experience exposures to infectious diseases each year through needlestick injuries. This has resulted in the use of needle-free devices.
Unfortunately, many of these devices have a common drawback: dead space. The volume of drug retained in the dead space of stopcocks and valves that are or not luer-activated can result in the delivery of an inadequate dose of anesthesia, or worse, the delivery of anesthesia during a subsequent flushing of the device, resulting in cardiac arrest or paralysis.
Dead space volume is the space inside the side port between the tip of the luer and the side close to the handle. Due to stagnation or residue after blood sampling or drug administration, a fluid left in the luer’s cavity may be prone to contamination or erroneous drug administration, leading to potential risk for the patient.
This phenomenon is particularly catastrophic in the case of children. The National Health Service of England has reported a number of cases in which severe or moderate harm to the patient resulted after intravenous anesthesia left in the cannula, or in the intravenous line distal to a site of drug injection was flushed into the patient’s circulation system. Further, the NHS states the occurrence is grossly underreported.
In agreement with the NHS, the publication Anaesthesia, the Journal of the Association of Aneasthetists of Great Britain and Ireland, reported that accidental administration of residual neuromuscular-blocking drugs occurs more often than is reported, and suggests it is a serious issue. Authors cited in the journal reported that Suxamethonium is usually administrated at a dose of 1-2 mg.kg-1. The ED95 (amount of drug that produces a therapeutic response in 95 percent of the population) of Suxamethonium was studied in children one to sixteen years of age using electromyography and was found to be 445 μg.kg-1 in children aged one to four years, 454 μg.kg-1 in those aged five to ten, and 270 μg.kg-1 in children of eleven to fifteen. The dead space volume of a standard stopcock side port is approximately 0.136 ml which is equivalent to approximately 6 mg of Suxamethonium. Accidental flushing of 6 mg Suxamethonium into a child may result in the child’s death. Suxamethonium is just one example of many that emphasizes the importance of a minimal dead space volume.
In addition to the inadvertent administration of anesthetics, overdose of insulin and resulting hypoglycemia was also reported, as well as other hazards associated with dead space in valves, like mixing of incompatible drugs in the line that may lead to precipitation.
Luer-activated devices with an internal channel minimize the likelihood of this event because the internal volume is constantly flushed by the in-line flow, ultimately minimizing dead space and ensuring the complete rinsing of the drug from the system. This system greatly reduces the chance of drug interactions and unintentional administration of residual drugs.
The increasing attention on patient and care-giver safety is leading the medical disposable devices industry to allocate a substantial amount of resources to provide health systems with safer, more efficient and more reliable products like luer-activated minimal residual volume stopcocks.
If you’d like to learn more about how luer-activated stopcocks with internal circumferential channels can reduce the hazards involved with anesthetic resides in ICU IV lines, we’d like to offer you a complimentary copy of the white paper we’ve been referring to: Elcam Medical’s New & Innovative Minimal Residual Volume Luer-Activated Stopcock.
Access yours today, and we’ll see you next time as we continue to examine Safety In the ICU.
