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Clinical impact of failure to administer medication left inside intravenous infusion material: a study of acetaminophen loss

García Matarín A, Tomás Vecina S, Portero Salmerón J, Pozo Adamúz F, Ortega Regueiro V

Servicio de Urgencias. Hospital Universitario Mútua de Terrassa. Barcelona, Spain. Servicio Integral de Urgencias y Emergencias. Hospital Municipal de Badalona. Badalona Serveis Assistencials. Barcelona, Spain.

Objectives: To determine whether acetaminophen is retained inside intravenous infusion
material after intermittent administration of fluids in the emergency department and
whether such retention has an effect on outcomes.
Methods: Prospective, observational study in the first phase, followed by a second phase
to analyze the effect of instruction and intervention. In the first phase, the completeness
of intravenous administration of medication and the patient’s response to therapy were
recorded. In the second phase, after instruction to improve the staff’s technical
performance of intravenous infusion of medication, completeness of administration and
patient response were again recorded. The medication studied was acetaminophen (1 g)
administered through an intravenous line. Variables recorded were age, sex, weight,
duration of infusion, residual volume left in the intravenous infusion equipment, score on
a pain scale and/or temperature (at 15 minutes, 1 hour, and 4 hours), and plasma
concentration of acetaminophen at 4 hours. The study population consisted of male and
female emergency department patients aged 15 years or older who were prescribed 1 g
of intravenous acetaminophen.
Results: A total of 119 patients were enrolled; 60 were studied in the first phase and 59 in
the second. In the first phase, in no cases had the infusion equipment been purged.
Intravenous administration took a mean (SD) of 25.7 (10.9) minutes during this phase.
Omission of a purge maneuver led to leaving a mean residual volume of 12.65 (2.95) mL
in the bottles; the mean plasma concentration of acetaminophen in the first phase (no
instruction to purge) was 4.28 (5.04) mg/mL in the first phase and 5.27 (4.42) mg/mL in
the second, after the staff had been instructed to purge. We observed a statistically
significant relation between drug plasma concentration and pain relief at 4 hours (P=.05),
but no correlation between temperature and residual volume in the system.
Conclusions: The volume left inside intravenous infusion material is considerable and can
have an effect on clinical response and therapy. We believe routine purging of intravenous
infusion system is necessary.

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