Multidose antibiotic vials in OR?

[NRSKarenRN, BSN, RN]

Had another OR incident--this time with family member being treated for first episode kidney stones (5 total) with lithotripsy. Otherwise young, healthy 250lb allergic to cephlosporins was to be given 80mgIV single dose in OR ; Instead was given 800mg by CRNA.

Urologist promptly informed me of error. Pt given 4 litters IV fluids in OR to flush system and doc conferred with infectious disease (ID) (most experience with lg dose antibiotics doc figured). Gent level 48hrs later--no trace and creatine 1.0 so most likely no damage. Anesthesiologist met with me along with apologized along with ID doc---will be doing own review.

Following up with letter to Quality improvement re incident asking that review of multidose antibiotic vials in OR be done to minimize potential error in future patients ---concern what would have happened in older person with multisystem disease.

How frequently do CRNA's give pre-op antibiotics using multidose vials...

Am I off base here with my request?

[Marie_LPN, RN, LPN, RN]

We don't even have multi-dose vials in our OR.

[heartICU]

We don't even have multi-dose vials in our OR.

We don't either.

[loisane]

A very unfortunate incident. Glad the outcome was acceptable.

I have never even seen a multidose vial of gentamycin, or any other antibiotic.

loisane crna

[jwk]

Ditto here as well - antibiotics here are usually unit dose from the manufacturer or pre-mixed by the pharmacy. The message all around seems to be use single dose vials. I'm not sure I've ever seen multidose vials of antibiotics, and if they're available, I'll bet they're supposed to be used for admixture by your hospital pharmacy only. Any chance those vials were there by mistake, or are they normally present on your carts?

[athomas91]

i likewise in nursing nor nurse anesthesia have ever seen a multidose abx vial.

i agree w/ jwk - sounds like the pharmacy placed the wrong vial out for disposal...

[TPfan24]

Speaking of mlti dose vials has any one seen or used multi dose syringes of Roxanol? We had a recent experience of getting multi dose syringes of 1ml =20mg. Ordered dose 5 to 10 mg. No med dropper available to draw up dose. Hospice patient got the 20mg when attempting to give prescribed dose po. Facility will not be using them any more.

[subee, MSN, CRNA]

Had another OR incident--this time with family member being treated for first episode kidney stones (5 total) with lithotripsy. Otherwise young, healthy 250lb allergic to cephlosporins was to be given 80mgIV single dose in OR ; Instead was given 800mg by CRNA.

Urologist promptly informed me of error. Pt given 4 litters IV fluids in OR to flush system and doc conferred with infectious disease (ID) (most experience with lg dose antibiotics doc figured). Gent level 48hrs later--no trace and creatine 1.0 so most likely no damage. Anesthesiologist met with me along with apologized along with ID doc---will be doing own review.

Following up with letter to Quality improvement re incident asking that review of multidose antibiotic vials in OR be done to minimize potential error in future patients ---concern what would have happened in older person with multisystem disease.

How frequently do CRNA's give pre-op antibiotics using multidose vials...

Am I off base here with my request?

According to medsave.gov, gentamicin, in its most potent strength, is available at a 2cc vial containing 80 mg. Antibiotics are not available in multi-dose vials. Please let us know what you find out from the review - very interested to discover how this error happened. Thanks.

[66F]

McNamara, DR, Nafziger, AN, Menhinick, AM, Bertino JS, , Jr

A dose-ranging study of gentamicin pharmacokinetics: implications for extended interval aminoglycoside therapy

J Clin Pharmacol 2001 41: 374-377

You may want to review this article. High dose gent is getting alot of press lately. This article mentions doses up to 7mg/kg

66f