Hi Everyone!

Thank you all for listening and sending me comments about the Push Dose Pressor episode that was released a few days ago.

A safety issue has come up about mixing epinephrine for push dose concentrations and it warrants a follow-up comment.  Everyone thank Craig Button, RN!

It is advised to NOT used pre-filled NS saline flushes to mix because there have been reported errors where the flushes are lying around unlabeled and have caused harm to patients because practitioners thought they were pushing a NS saline flush of 10mL.

Therefore, I have updated my preparation instructions in the original blog post to draw up NS 9mL into an empty 10mL syringe, then draw up the epinephrine as instructed.

Personally, I have never had an issue with the pre-filled flushes but I’m also a little crazy and refuse to even start mixing or drawing up medications unless I have filled out a label (this includes drawing up intubation meds and mixing drips) ready to place IMMEDIATELY after preparation. Literally the medication and syringe does NOT leave my hands or eyesight – I do NOT step away from my preparation until it is completely labeled.  Otherwise – it gets tossed and I start over.  I argued with Craig on this but I cannot be the label police and at times of chaos – things happen so it’s best to avoid any mistakes if prevention is possible.

It is best practice to label all of your medications that are drawn up or mixed. This is even more important when you are working on very sick patients who very well may code on you – the less confusion the better. You don’t know who is going to come into your resuscitation bay and start helping out. There’s no guarantee that you will even remember what your concentration or the amount of medication you drew up in the middle of a code or almost code. This is the best method to prevent errors.

The last thing I want is for medication errors to happen due to confusion over whether a saline flush is a saline flush – or has medication in there.  Remember, epinephrine can cause arrhythmias!

Finally, if you do use saline flushes – I recommend to always use a saline flush that you have to open up the individual packaging and to never use a saline flush that has been lying around.

Yun Cee

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