Use and abuse of intravenous solutions

Recent microbial infusion disasters underline the fact that infusions carry a substantial risk of morbidity and mortality. Those who make a habit of setting up an intravenous infusion as a convenient route for the administration of drugs, or just in case it may be needed later, would do well to review their methodsmthe increased probability of contamination and subsequent patient infection by the practice of adding drugs to intravenous fluids is not generally recognized. To reduce the possibility of microbial contamination, the open system with tube containers should be opened only in an aseptic environment, eg, a laminar flow hood, to allow the vacuum to be replace by aseptic air; the open-system containers should be opened only in an aseptic environment, and a bacterial filter should be inserted in the air entry port of the closure. Routine monitoring of intravenous solutions for microbial contamination should be standard procedure for any institution providing intravenous fluid therapy to patientsmthe following recommendations are suggested for consideration by hospital pharmacy and therapeutics committees: 1, The addition of drugs to intravenous fluids should be discouraged except in recognized cases of emergency. 2 when the addition of drugs to intravenous fluids is indicated, only one drug should be added to an intravenous fluid, and the only intravenous fluids used for this purpose should be isotonic saline or 5% dextrose solution in water. More complicated electrolyte solutions and protein hydrolysate solutions should never be used for additive purposes. Guidelines should be established in hospitals for the addition of drugs to intravenous fluids. These guidelines should be followed by trained personnel who have access to all available compatibility data. Additions should be made under aseptic conditions by trained personnel, preferably in the hospital pharmacy. 4. All additions of drugs should be included in the patient's permanent drug file, and the intravenous container should be clearly labeled before administration. 5. Critical attention should be directed to the administration equipment used for intravenous solutions, particularly volume control sets. Consideration should be given to the routine use of terminal in-line millipore filters to prevent the infusion of particulate matter and to minimize microbial contamination. In emergency situations when it is necessary to add drugs to an intravenous fluid by the bedside, the addition should be made in accordance with established hospital procedure and should be subject to periodic monitoring. Each hospital pharmacy and therapeutics committee should give serious consideration to the establishment of a continuous admixture monitoring system and quality control program. Such a program will provide valuable information regarding sources of contamination rates and will provide invaluable information in planning in-service education and training programs pertaining to intravenous therapy preparation and administration.