IV Paracetamol: Bags not Vials

The delivery of paracetamol from a glass vial allows air to enter the intravenous giving set risking venous air embolus. Paracetamol is already presented in bags which don’t entrain air and is used in this form without issue in many hospitals.

The distraction afforded through keeping a watchful eye on glass vials of paracetamol to avoid air entrainment may detract from patient care. When air does enter the giving set it requires time and an additional syringe to remove it.

Perhaps it would be ideal if worldwide intravenous paracetamol were only provided in bags.

– If you know of any institution supplying intravenous paracetamol in glass vials provide them with a copy of this post.

– We should create a list of manufacturers of intravenous paracetamol in glass vials (e.g. Fresenius Kabi) and write a letter to their CEO requesting they consider changing to supply it in bags. Anyone who sees a manufacturer supplying intravenous paracetamol in glass vials should add to this list.

– We should develop a list of suppliers of intravenous paracetamol in bags for distribution to those institutions currently supplying it in vials.
This issue may seem trivial however it provides a great example of the culture we have been nurtured in.

Perhaps we put up with these issues because we can and doing so satisfies our egos. But should we? Shouldn’t we be doing everything we can to remove unnecessary hazards. Perhaps current healthcare culture doesn’t support this attitude.

Perhaps it would be a good exercise for hospital managers to truly understand why front line staff haven’t brought these issues up with them earlier in a sufficient manner to have them resolved.

That this unnecessary hazard exists in our hospitals is testimony that we’ve become too numbed to improve our front line environments. Front line staff have been nurtured in healthcare with a paucity of frameworks to improve working conditions.

That there are no systems for reporting hazards conveys a message that front line staff should just put up with their work environments.

As healthcare stands few will be criticised if we maintain the status quo, keep quiet about the hazards yet present the adverse events which occur because of their presence into inneffective opaque reporting systems. As a result the same adverse events repeat again and again and again.

If we are to improve we need the frameworks to allow it. Matthew Syed in his book, Black Box Thinking, points out that we need the ability to improve what might seem like the smallest of issues – the ‘one percenters’. He goes on to demonstrate this is how the British Skye racing team has used this ability to come from nowhere to dominate the Tour de France.

Despite health care relying on ‘root cause analysis’ to review major adverse events there is never one root cause. Adverse events occur because of a series of ‘holes in a piece of cheese’ – we need to be awakened from our slumber in healthcare and start to remove all of the unnecessary holes however trivial they might seem.

Welcome to the PatientSafe Network.


One Comment

  1. Medsafetypharm

    Infusion bags are good for adults when the whole infusion volume (1g/100ml – or 500mg/50ml in low body weight adults) is being administered. In paediatrics the infusion volume is drawn up from a vial and administered via a syringe.

    The risk with infusion bags is confusion with non-drug containing infusions e.g. 100ml sodium chloride. Unless the labelling of infusions is improved the risk is there. In the image there is a foil seal over the port. Not sure whether this has been placed there by the manufacturer. If it has, that would be a great opportunity to add another reminder to the user of the drug they are handling. Simply write in strong, clear, bold lettering PARACETAMOL on that tag that has to be removed before the giving set is attached. If the bag has been accidentally misselected this would provide another barrier to error.

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