Med error? help im going to loose ky mind thinking about this!!!!!!

[avenellpn82]

Ok I'll try to be short. So I have been giving rochephin with lidocaine IM for the past four days its two grams. Now today the last day of the ABT I go to my charge nurse RN to get a 3 ml syringe she tells me I should use a 5 ml. I thought I was wrong all along giving this patient too little of a dose. Now when I looked at the syringe I felt that something was wrong but again my charge nurse told me it was correct so I gave the injection. When I came out of the patients room the DON asked me why did I look so nervous so I told her I just gave a patient an IM with a 5 ml syringe and she is so frail that it just scared me a little. Soooooo now how it gets to a med error......... She asks me what med it was and some other questions about the patient then she says what's the most an IM should be I replied 2 ml then she says well that's a huge med error u gave her dble the dose of lidocaine. Now even though the charge nurse told me to do this I now feel so damn stupid because I know that if u feel unsure about something u should check other resources and btw to make it worst I always have my lipincott clinical skills book :-(

Now the question...... This is my first med error what should I expect? I am freaking out.

[1uvakindmom]

yes, this doesnt make any sense to me.

[avenellpn82]

why the lidocaine? That is what i don't understand.

Plus - if i understand correctly, you had been using a 3 ml syringe - how were you giving 5 mls of lido if you only have a 3 ml syringe? In fact - how did you give the rochephin? You had a 5ml syringe, and order was for 2 grams of rocephine plus 5 ml lido - no matter what concetrate of the rochephine. Or were they already mixed together and you had to give 5 mls? Even then, i return to my original question - how were you giving it before using the 5 mls.

I am very confused.

because according to the order it was to be 2 mls total after reconstituting with the lido.

[Pepper The Cat, BSN, RN]

because according to the order it was to be 2 mls total after reconstituting with the lido.

Then why the 5 ml syringe?

What did you give?

If you only gave 2 mls then you are fine.

I must be more tired that I thought because I am still very confused.

[ckh23, BSN, RN]

You can't give a single 5ml injection of anything, no matter what the order says. Something is amiss here.

Sure you can, some meds come in 5 ml syringes for IM use only. With a dose that size the manufacturers usually recommend using the buttocks.

[nurseryRN14]

No matter what syringe you use, you still give only what the doctor says. I know you can only give 2ml's injection at a time. What was the med error? Did you give too much lidocaine?

[opossum]

because according to the order it was to be 2 mls total after reconstituting with the lido.

So, then the order was written wrong if both the Rocephin + lidocaine = 5ml.

[kcksk]

Ok you need to know what you have. In our office we have 1g vials and we reconstitute with 1.4ml sterile water. Not sure on the lidocaine. When we give the 1g we ALWAYS break it up into two injections because we give no more than 1ml per injection area. The reconstitution rate is 350mg/ml so if you needed to give 2 g of that you would be giving 5.7 ml if you had that 350mg/ml ratio. Not sure what you had for strength and the reconstitution. We do give consecutive days IM injections in the office we work if it is needed because there is no iv access.

[eslvn]

When I have given rocephin, the pharmacy delivered it with the lidocaine and it had directions written on it, if you arent sure then get clarification. Med errors usually arent the end of the world unless it causes harm to the patient, it happens learn from your mistakes.

[linearthinker, DNP, RN]

Sure you can, some meds come in 5 ml syringes for IM use only. With a dose that size the manufacturers usually recommend using the buttocks.

huh. You learn something new every day. I was taught 2ml was the max. Of course, that was over 25 years ago, but I had never been told differently until now. Do you have a link to some EBP about this?

[tyvin, BSN, RN]

The Rocephin bottle will tell you how much to water to use to reconstitute. I can't remember what it is but if the Rocephin is ordered with lidocaine all you do is use the lidocaine in place of the water. Also never put more then 2 mls anywhere including the buttocks ... you break it up into two injections if the amount exceeds 2 mls. To end; why wasn't this person given Rocephin IV? It's researched like crazy the best way for it to be absorbed is via IV. They should have had a saline lock and been receiving the Rocephin IV.

[moonchild20002000]

avenellpn82,

google PDR and look under Rocephin IM....you will find all the information you need.

[Isabelle49]

I don't understand why the patient wasn't given this drug IV.