I had a patient yesterday and the doctor gave an order for Decadron. I checked the patient's allergies as noticed she had an allergy to Solu-Cortef (although the patient has successfully taken Solu-Medrol and prednisone in the past). Anyhoo, since both are corticosteroids, I started questioning the order. Called the pharmacy first, not much help, so called the MD. MD said a reaction was unlikely, but changed the order to Solu-Medrol IV.
So, the pharmacy sends up the med. They substituted methylprednisolone, no problem. So, I look in my drug guide which states to administer slowly and is compatible with NS. Prepare the syringe for IV push.
Come to find out, the patient's INT was occluded. She was African American and a hard stick, so it took 3 of us and about an hour until we could get a new INT started.
By this time, I notice that the medication had precipitated inside the syringe. So, I ask my preceptor about it, and she tells me to shake the syringe before administering. Hmmmm? So, I ask another nurse who takes a look and says something's not right.
So, we go back to the vial, and now notice that the vial says Not for IV use, for IM injection only. Turns out that the pharmacy sent methylprednisolone acetate instead of methylprednisolone sodium succinate.
Never having given Solu-medrol before, I didn't know what kind of vial it should come in, or that there were different forms of the drug. THANK GOD that the med precipitated which caused me to question the med. Had it not precipitated, I know that I would have pushed the med.
I have always double checked the med and dose, but never thought about reading the vial closely enough to notice the fine print. What could I have done differently? Of course, I will check this from now on, but I'm just freaked out about how close I came to making this error.
The charge nurse filed an incident report to hopefully bring light to the potential error. Does anyone happen to know what kind of reaction could have occurred? I'm almost scared to ask.
Specializes in ER, ICU, Infusion, peds, informatics.
i had a patient yesterday and the doctor gave an order for decadron. i checked the patient's allergies as noticed she had an allergy to solu-cortef (although the patient has successfully taken solu-medrol and prednisone in the past). anyhoo, since both are corticosteroids, i started questioning the order. called the pharmacy first, not much help, so called the md. md said a reaction was unlikely, but changed the order to solu-medrol iv.
so, the pharmacy sends up the med. they substituted methylprednisolone, no problem. so, i look in my drug guide which states to administer slowly and is compatible with ns. prepare the syringe for iv push.
come to find out, the patient's int was occluded. she was african american and a hard stick, so it took 3 of us and about an hour until we could get a new int started.
by this time, i notice that the medication had precipitated inside the syringe. so, i ask my preceptor about it, and she tells me to shake the syringe before administering. hmmmm? so, i ask another nurse who takes a look and says something's not right.
so, we go back to the vial, and now notice that the vial says not for iv use, for im injection only. turns out that the pharmacy sent methylprednisolone acetate instead of methylprednisolone sodium succinate.
never having given solu-medrol before, i didn't know what kind of vial it should come in, or that there were different forms of the drug. thank god that the med precipitated which caused me to question the med. had it not precipitated, i know that i would have pushed the med.
i have always double checked the med and dose, but never thought about reading the vial closely enough to notice the fine print. what could i have done differently? of course, i will check this from now on, but i'm just freaked out about how close i came to making this error.
the charge nurse filed an incident report to hopefully bring light to the potential error. does anyone happen to know what kind of reaction could have occurred? i'm almost scared to ask.
i would say that pharmacy is at fault for sending the wrong drug, and your nursing skills enabled you to catch a potential error.
if i'm reading this right, you are assuming that you got "lucky" that your patient's iv went bad; and that because she was a hard stick, the medicine sat long enough in the syringe to allow it to precipitate.
that isn't the case. the acetate form ("depo medrol") is a milky-white suspension (sort of like nph insulin). the precipitate was there the whole time. you should always check for precipitate before giving an iv med -- which you did, even if you didn't consciously think "i'm checking for precipitate (and other odd things like funny color) now."
i think you would have noticed it even if you had gone to give it right away.
as for what could have happened -- i'm speculating here -- but i think some of the particulate matter can become emboli in small vessels.
good catch.
(fyi, for those of you who are new -- there are very few iv meds that aren't clear. by "clear," i mean see-through, not colorless. anytime you are about to hang/push an iv med that isn't clear, you need to confirm that it is ok. lipids and diprivan are two drugs that come to mind quickly -- they are both thick, white, and opaque. albacet (amphoteracin b lipid) is a milky orange/yellow -- a little bit like tang -- and it isn't completely opaque, but it can't be called "clear," either. those can all be given iv. but they are also all uniform suspensions (homogenous). none of them have particulate matter. i can't think of a single iv med that has precipitate or particulate matter in it, by design. however, there are several meds that will precipitate if they have been mixed too long, or are at the wrong ph, or get mixed with an incompatible med -- like dilantin and dextrose. and these meds are not safe to give once they have precipitated. so, a good rule to follow: if you can't see through it, call pharmacy before you give it iv).
SuesquatchRN, BSN, RN
10,263 Posts
I think you're a very careful new nurse and should be commended.
:)