GTN use in cardiac cath labs

[Michael Wishart]

Can I ask a possibly thorny question here, please? How many facilities with cardiac cath labs use a single GTN concentrate vial (they only come in 50mg/10mls vials) for each patient that requires a few micrograms of diluted GTN during a procedure? We are having a debate here about whether dispensing GTN concentrate into saline bags for use on multiple patients is ‘mulit-dosing’. In my view, the dispensing of each dose to the patient is from a saline bag, not the vial, so we should use a separate saline bag for each patient, not a separate vial for each patient.

I am aware of what is the section B4.1.2 of the 2010 NHMRC infection control guidelines.

Thoughts? What happens in other cath labs currently?

Looking forward to some interesting discussion on this old chestnut!

Thanks
Michael

Michael Wishart
Infection Control Coordinator
Holy Spirit Northside Private Hospital
627 Rode Road, Chermside, Qld 4032
t: (07) 3326 3068 | f: (07) 3607 2226
e: Michael.Wishart@svha.org.au
w:www.holyspiritnorthside.org.au
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[Haig, Rachael]

Greetings Michael,

At our cath lab at Westmead Private Hospital we currently use separate GTN vials for each case. Wastage is monstrous, however our concern is that we could inadvertently cross contaminate as there is no way to “close” the vial between cases, and every case we do not use GTN. This would mean the vial would sit there open awaiting usage.

Also there would be no point in “pre-dosing” bags for cases in the morning, all at once (like we do with heparin bags, we make them up in the morning for the days cases) as some days we don’t even use one GTN vial!

Would be interested in what other departments do too. I really wish there was a smaller concentrate of GTN, as we usually give 200mcg doses when bolusing etc – it’s miniscule amounts and such a waste.

With kind regards,

Rachael Haig | RN
Infection Control Co-ordinator

Cardiac Cath Lab | Westmead Private Hospital
Cnr Mons & Darcy Roads, Westmead NSW 2145
t: 02 8837 9526 | f: 02 9687 9095
e: HaigR@ramsayhealth.com.au | w: http://www.ramsayhealth.com.au

[http://www.ramsayhealth.com.au/images/email/RHC-email-2013.jpg]

Can I ask a possibly thorny question here, please? How many facilities with cardiac cath labs use a single GTN concentrate vial (they only come in 50mg/10mls vials) for each patient that requires a few micrograms of diluted GTN during a procedure? We are having a debate here about whether dispensing GTN concentrate into saline bags for use on multiple patients is ‘mulit-dosing’. In my view, the dispensing of each dose to the patient is from a saline bag, not the vial, so we should use a separate saline bag for each patient, not a separate vial for each patient.

I am aware of what is the section B4.1.2 of the 2010 NHMRC infection control guidelines.

Thoughts? What happens in other cath labs currently?

Looking forward to some interesting discussion on this old chestnut!

Thanks
Michael

Michael Wishart
Infection Control Coordinator
Holy Spirit Northside Private Hospital
627 Rode Road, Chermside, Qld 4032
t: (07) 3326 3068 | f: (07) 3607 2226
e: Michael.Wishart@svha.org.au
w:www.holyspiritnorthside.org.au
Please consider the environment before printing this email

[http://www.interactivejam.com.au/images/ACIPC-conference.jpg]

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