medication error

Double-Helix, BSN, RN · Oct 5, 2016

Are you a student? Did you report the error when you realized it occurred? As a student, it's important to look up the pharmacokinetics and standard dosing of a drug. If you did that for alteplase, you would find that the half life is about 4-26 minutes depending on the concentration, which means that the medication will be well out of this patient's system by the time you return. You'll also find that 4mg is a negligible dose compared to the amount given for MIs or occlusive strokes.

heyimnewhere · Oct 6, 2016

Are you a student? Did you report the error when you realized it occurred? As a student, it's important to look up the pharmacokinetics and standard dosing of a drug. If you did that for alteplase, you would find that the half life is about 4-26 minutes depending on the concentration, which means that the medication will be well out of this patient's system by the time you return. You'll also find that 4mg is a negligible dose compared to the amount given for MIs or occlusive strokes.

not a student. i did this towards the end of shift when i was trying to pull blood for labs, but realized it was clotting. it was ok when i started. i forgot to mention it, until was almost out the door. the oncoming shift already put a saline flush through it, though.

i called the MD and the pharmacist. MD told me not to worry about it. pharmacist wasn't any help. the oncoming nurse flipped a lid and told me now the patient is going to go into DIC. i never used this drug before. she has 10+ years... i have 3 years. i'm worried. that's all.

Double-Helix, BSN, RN · Oct 6, 2016

This is the nursing student forum, which is why I assumed you were a student.

He'll be fine. If he already had internal bleeding or clotting issues you might be more concerned, but like I said, it's a small dose. Not to mention, the internal volume of the catheter is much less than 4mL anyway, so most of the dose was already in systemic circulation before the remainder was flushed from the catheter.

jinny2009 · Oct 9, 2016

it is always a good idea to report it. that is my rule of thumb

Here.I.Stand, BSN, RN · Oct 9, 2016

the oncoming nurse flipped a lid and told me now the patient is going to go into DIC. i never used this drug before. she has 10+ years... i have 3 years. i'm worried. that's all.

If that were a 100+ kg stroke pt you'd be giving 90 mg -- 10% of that over a minute and the rest over an hour. (0.9 mg/kg with maximum of 90 mg.)

You did the right thing reporting it, I'm sure you'll never do that again, but the lid flipping was completely unnecessary.

She should also review the pathophysiology of DIC. We give a LOT of tPA at my hospital, and have never heard of DIC being considered one of the risks, never read anything about DIC in association with tPA administration.