Miscellaneous
I’m not a powerful Jedi Master with Force Visions and frankly, unable to see into the future. Hello Star Wars fans! This is a follow-up bonus episode in response to Episode 5 Push Dose Pressors, listeners' questions, and also in light of recent journal articles that recently got published. Timing was completely coincidental when Episode 5 Push Dose Pressor podcast episode was released. Although I’ve been using push dose pressors for years now, I still researched the topic awhile ago. Frankly, there wasn’t much out there - and there still isn’t. Why? Because it’s not standard of care. But I suspect it will be once there are RCTs and more research and we all know that takes time. Meanwhile, this is a practice that is happening in our Emergency Departments and as ED nurses, we definitely should know about them. This is the initial reason for a push dose pressor episode on this podcast. Nurses, we are going to be the ones mixing and preparing the push dose pressors, and a good chance we will be administering it. These medications, epinephrine and phenylephrine, are extremely potent and should be highly respected when used. It also warrants an increased awareness of the entire process - including when to use them, and what safety measures we can use to prevent medication errors. So let’s go over some safety measures that will ensure the correct utilization of push dose pressors. 1. Mixing/Preparing Epinephrine Push Dose Pressor Let’s start with preparing an epinephrine push dose pressor - After I had released my podcast, a nurse listener, immediately brought to my attention that using pre-filled saline flushes to prepare the epinephrine push dose concentration is bad because it can lead to medication errors. I definitely argued that I don’t see the difference between using a pre-filled saline flush for a push dose pressor versus a pre-filled saline bag for a drip - as long as it is labeled properly (use concentration doses). More responses came and a major safety issue came up that health care providers are NOT labeling their syringes after mixing - why??!! And there has been reported errors in medication where health care providers are mistakenly pushing what they think is a NS flush syringe - but it actually has medication in them (epinephrine or other medications). This gave me a heavy heart - and you know, I wanted to puke a little bit. I hope you all can forgive me. The last thing I would ever want to endorse is an unsafe practice, or a practice that can lead to even more errors. That being said, I will change my own practice to draw up epinephrine in an empty syringe and dilute it to a proper push dose concentration - and immediately label the syringe afterwards. Never let that syringe out of your hands or eyesight until the label is securely on the syringe. Epinephrine is a medication that is prone to errors to begin with. Some additional tips on mixing: Labeling Always label where you can still see your mL markings on the syringe - it’s important that way you know how much you are giving! This also applies to other medications like your intubation meds.. Why Use Cardiac Pre-filled Syringes? You may wonder why it is recommended to mix from a cardiac pre-filled syringe - it’s because you can guarantee the concentration (1:10000 with 10mL). Many medication rooms will have different concentrations stocked 1:1000 for anaphylaxis or 1:10000 for cardiac arrest - but both are in 1mL vials. If you were to grab the vial of Epinephrine 1:10000 in 1mL - you are supposed to further dilute that before administering. So when your patient is crashing, to prevent thinking it even further, it’s easier to grab the cardiac pre-filled syringe because you know it will have a concentration of 1:10000 in 10mL. Maintain Sterility When mixing, try to maintain sterility as much as possible. Remember all medications will go into the blood stream, we do not want to introduce more problems.