Infusion: Drug Protocols

1. Safe drug administration depends on the practitioner having a full understanding of the pharmacological profile of a given drug.   These drug infusion protocols are not a substitute for knowledge of indications, contra-indications, side-effects, special precautions, kinetics and dynamics of each individual drug.
2. It is incumbent upon all practitioners to follow HPCSA protocols and institutional policies, and to seek advice and clarification when in doubt.
3. NOT ALL DRUG CAUTIONS HAVE BEEN DOCUMENTED IN THIS PROTOCOL.
4. Always label solutions clearly, documenting generic drug name, diluent, concentration, patient name, time and date of mixing, and the name of the practitioner who mixed the drug.
5. It is always a good idea to ask a colleague to double-check your drug infusion mixtures, and to document this in the patient’s clinical record.
6. When documenting a drug infusion in the patient’s clinical records, be sure to document the drug name, drug concentration mixed, rate administered, and time commenced.   It is an accepted standard of care and is institutional policy.   Failure to comply with this exposes the patient to clinical risk, and both the individual practitioner and the institution to medico-legal culpability.
7. When mixing drugs for infusion:
8. Check that the diluent is compatible with the drug.
9. Remember to first remove an equal volume of diluent from the total diluent volume, equal to the volume of ‘neat’ drug to be added to the diluent.
10. The drug dosages and volumes specified in these protocols are intended for use with a 50ml syringe driver.   If you are mixing solutions of 100ml, multiply drug dose/volume by two; and if mixing 200ml volumes, multiply by four.   Infusion rates remain unchanged.
11. Be cautious when flushing inotropes – very small volumes of relatively dilute inotrope can have catastrophic effects when even small boluses are administered in an uncontrolled manner.   When replenishing and reloading syringes into the syringe driver, disconnect the syringe from the administration tubing first.
12. When using very low infusion rates, check dead space volumes in administration sets and IV catheters (esp. central lines).   It may be prudent to halve the concentration and double the flow-rate when dead space volumes are large and/or when flow rates are low

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Courtesy Dr. John Roos. Mitchells Plain Hospital. Department of Anaesthesia

References for Infusion Guides:

• South African Medicines Formulary, 11^th edition.Division of Clinical Pharmacology. University of Cape Town.
• Drug Doses, 14^th edition.Frank Shann. Intensive Care Unit. Royal Children’s Hospital. Pareville, Victoria, Australia.
• Royal Flying Doctor Service Western Operations: Clinical Manual.Part 2: Drug Infusion Guidelines. Version 5, June 2008.
• Drugs in Anaesthesia and Intensive Care, 3^rd edition.Susada M, Smith S. Oxford Medical Publications.
• Oxford Handbook of Anaesthesia, 2^nd edition. Allman K and Wilson I. Oxford Medical Publications.