The Operating Theatre Journal April 2022

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Risk of medication errors withtranexamic acid injection resultingin inadvertent intrathecal injectionWHO is alerting health care professionals about the risk of administrationerrors that can potentially occur with Tranexamic Acid injection. Therehave been reports of Tranexamic Acid being mistaken for obstetricspinal anaesthesia used for caesarean deliveries resulting in inadvertentintrathecal administration.Intrathecal TXA is a potent neurotoxin and neurological sequelae aremanifested, with refractory seizures and 50% mortality. The profoundtoxicity of intrathecal TXA was described in 1980. A 2019 reviewidentified 21 reported cases of inadvertent intrathecal injection of TXAsince 1988, of which 20 were life-threatening and 10 fatal. Sixteen werereported between 2009 and 2018.WHO recommends early use of intravenous TXA within 3 hours ofbirth in addition to standard care for women with clinically diagnosedpostpartum haemorrhage (PPH) following vaginal births or caesareansection. TXA should be administered at a fixed dose of 1g in 10 ml (100mg/ml) IV at 1 ml per minute, with a second dose of 1g IV if bleedingcontinues after 30 minutes.TXA is frequently stored in close proximity with other medicines,including injectable local anesthetics indicated for spinal analgesia(e.g., for caesarean section). The presentation of some of the localanesthetics is similar to the TXA presentation (transparent ampoulecontaining transparent solution), which can erroneously be administerinstead of the intended intrathecal anesthetic resulting in seriousundesirable adverse effects.Endo Begins Shipment ofPremixed Ephedrine SulfateInjection in Ready-to-Use VialsEndo International plc announced recently that its Par Sterile Productsbusiness has begun shipping premixed Ephedrine Sulfate Injection in aready-to-use 50 mg/10 ml single-use vial.“We are pleased to launch this new ready-to-use product as part of ouragreement with Nevakar,” said Scott Sims, Senior Vice President andGeneral Manager, Sterile Products at Endo. “This is a demonstrationof our commitment to deliver quality, life-enhancing therapies tohealthcare providers—when and how they need them.”Ready-to-use, or RTU, products help streamline operations for hospitalsby eliminating the need to prepare or transfer the product beforepatient administration. This may reduce waste and costs, optimizeconvenience and workflow, and heighten accuracy and compliance byreducing the chance for preparation error—all of which support qualitypatient care.This is the first product launch under the previously announced exclusivelicensing agreement between Nevakar Injectables, Inc., a privatelyheld biopharmaceutical company, and Endo’s subsidiary, Endo VenturesLimited (EVL). Under the agreement, the companies are collaboratingon five differentiated sterile injectable products in the U.S. Nevakar isresponsible for developing the drugs and obtaining approval from theU.S. Food and Drug Administration, and EVL is responsible for productlaunch and distribution through Endo’s Par Sterile Products business.SOURCE Endo International plcRecently, obstetricians from several countries have reportedinadvertent intrathecal TXA administration and related seriousneurological injuries.TXA is a lifesaving medicine, however, this potential clinical risk shouldbe considered and addressed by all operating theatre staff. Reviewingof existing operating theatre drug handling practice is required in orderto decrease this risk, such as storage of TXA away from the anaestheticdrug trolley, preferably outside the theatre.References:South African Medical Journal 2019;109(11):841-844. DOI:10.7196/SAMJ.2019.v109i11.14242Yamaura A, Nakamura T, Makino H, Hagihara Y. Cerebral complicationof antifibrinolytic therapy in the treatment of ruptured intracranialaneurysm. Animal experiment and a review of literature. Eur Neurol.1980;19(2):77-84. doi: 10.1159/000115131. PMID: 6893025.Patel S, Robertson B, McConachie I. Catastrophic drug errors involvingtranexamic acid administered during spinal anaesthesia. Anaesthesia.2019 Jul;74(7):904-914. doi: 10.1111/anae.14662. Epub 2019 Apr 15.PMID: 30985928.https://www.fda.gov/drugs/drug-safety-and-availability/fda-alertshealthcare-professionals-about-risk-medication-errors-tranexamicacid-injection-resultingJoin the South West Infection Control Network on 7-8 June 2022for Infection Prevention & Control Conference: From Introductionto Directors at Sandy Park Stadium in Exeter where renownedspeakers within infection prevention & control will come togetherto deliver an exciting and informative programme.Find out more and register for FREE: https://fitwise.eventsair.com/ipc-conference-exeter• DAY 1: 7 June 2022 New to Infection Prevention & ControlDay: For those new to the field of infection control linkpractitioners• DAY 2: 8 June 2022 Directors of Infection Control (DIPC) Day:For senior infection prevention practitionersThe event will draw upon some of the latest research and findingsnationally, which to date have not been shared or discussed due tothe constraints of the pandemic. Also featuring a large infectionprevention and control exhibition.22 THE OPERATING THEATRE JOURNAL www.otjonline.com
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