ALERT - Summary of corrections to the UCLH Injectable Medicines Administration Guide

Published January 2012

The date above refers to the date this news item was published on the website (January 2012). However, this news item refers to errors identified in the Injectable Medicines Administration Guide; specifically the third edition which was published in 2010.

 

Section 12.1 "Displacement Values"

Text currently states: After reconstitution the total volume of the solution is 5 mL + 0.2 mL = 5.2 mL. If the prescribed dose is 250 mg, then the practitioner should administer the full 5.2 mL to the patient. The concentration of amoxicillin in the solution is 96 mg/mL.
Perhaps a practitioner is working on a paediatric ward and the dose prescribed is 50 mg. To reconstitute the vial the practitioner should take into account the displacement value. The practitioner should add 4.8 mL water for injections to the vial, so that the concentration is 100 mg/mL. The volume of the dose is 0.5 mL.

Text should state: After reconstitution the total volume of the solution is 5 mL + 0.2 mL = 5.2 mL. If the prescribed dose is 250 mg, then the practitioner should administer the full 5.2 mL to the patient. The concentration of amoxicillin in the solution is 48 mg/mL.
Perhaps a practitioner is working on a paediatric ward and the dose prescribed is 50 mg. To reconstitute the vial the practitioner should take into account the displacement value. The practitioner should add 4.8 mL water for injections to the vial, so that the concentration is 50 mg/mL. The volume of the dose is 1 mL.

 

Adenosine monograph, dilution column, bottom row

Text currently states: Withdraw 38 mL from a 100 mL bag NS. Draw up 33.3 mL of adenosine 30 mg/mL and add to the bag to give a final concentration of approx. 1 mg/mL

Text should state: Withdraw 38 mL from a 100 mL bag NS. Draw up 33.3 mL of adenosine 30 mg/10 mL and add to the bag to give a final concentration of approx. 1 mg/mL

 

Ajmaline monograph, compatibility column

Text currently states: Compatible fluids: G
Do not infuse with any other medicines or infusion fluids
Compatible fluids: NS, G, GS

Text should state: Compatible fluids: NS, G, GS
Do not infuse with any other medicines or infusion fluids

 

Clonazepam monograph, comments column

Text currently states: (a) clonidine adsorbs to PVC so should preferably be given using PVC-free equipment. Non-PVC equipment held at UCLH at time of writing: Terumo/BD Plastipak syringes, B Braun Infusomat Space PVC-free Line, Baxter Viaflow infusion bags

Text should state: (a) clonazepam adsorbs to PVC so should preferably be given using PVC-free equipment. Non-PVC equipment held at UCLH at time of writing: Terumo/BD Plastipak syringes, B Braun Infusomat Space PVC-free Line, Baxter Viaflow infusion bags

 

Noradrenaline monograph

Delete insulin from the list of compatibilities under Y-site compatible when diluted in G or NS

 

Insulin monograph

Delete noradrenaline from the list of compatibilities under Y-site compatible when diluted in G or NS

Delete noradrenaline from the incompatible list

 

Vancomycin monograph, rate column

Text currently states: Doses up to 600 mg: give over 1 hour
Doses 601–1250 mg: maximum rate 120 mL/hour of the diluted solution
This is equivalent to a maximum rate of 10 mg/minute
See comment (b)

Text should state: Doses up to 600 mg: give over 1 hour
Doses 601–1250 mg: maximum rate 120 mL/hour of the diluted solution
Doses 1251 1500 mg: maximum rate 200 mL/hour of the diluted solution
This is equivalent to a maximum rate of 10 mg/minute
See comment (b)

 

Hydralazine monograph, in the rate column in the Hypertension (adults): (C) IV infusion via a syringe pump (unlicensed) row:

Text currently states: Initially 12 18 mL/hour, reduced to 75 150 mL/hour after an adequate response has been achieved
See comment (a)

Text should state: Initially 12 18 mL/hour, reduced to 3 9 mL/hour after an adequate response has been achieved
See comment (a)

 

List of contributors:

Please add the following name to the bottom of the list of contributors: Mrs Ravijyot Saggu, MPharm, Dip Clin Pharm, MRPharmS.

 

Morphine monograph, formulation column

Text currently states (over 2 pages): Ampoule
10 mg/1 mL
Non proprietary
Hameln (UK)

Ampoule
30 mg/1 mL
60 mg/2 mL
Non proprietary
Martindale (UK)

Ampoule
100 mg/50 mL
Non proprietary
Aurum t/a Martindale (UK)

Ampoule
100 mg/50 mL
Non proprietary
Aurum t/a Martindale (UK)

Ampoule
100 mg/50 mL
Non proprietary
Aurum t/a Martindale (UK)

Ampoule
10 mg/1 mL
Non proprietary
Hameln (UK)

Text should state:Ampoule
10 mg/1 mL
Non proprietary
Hameln (UK)

Ampoule
1 mg/1 mL (unlicensed)
15 mg/1 mL
30 mg/1 mL
30 mg/1 mL (preservative free)
40 mg/1 mL (preservative free)
60 mg/2 mL
Non proprietary
Martindale (UK)

Pre-filled syringe (unlicensed)
50 mg/50 mL
Non proprietary
Hospira (UK)

Ampoule
100 mg/50 mL
Non proprietary
Aurum t/a Martindale (UK)

 

Fentanyl monograph, formulation column

Text currently states: Ampoule
100 micrograms/2 mL
500 micrograms/10 mL
Non proprietary
Auden McKenzie (UK)

Text should state: Ampoule
100 micrograms/2 mL
500 micrograms/10 mL
Non proprietary
Auden McKenzie (UK)

Pre-filled syringe (unlicensed)
1 mg/50 mL
Non proprietary
Hospira (UK)

 

Tranexamic acid monograph, formulation column

Text currently states: Ampoule
500 mg/5 mL
Cycklokapron Pfizer t/a Pharmacia (UK)

Text should state: Ampoule
500 mg/5 mL
Cyklokapron Pfizer t/a Pharmacia (UK)

 

Desmopressin monograph, dilution column

Text currently states: Add dose to 50 mL NS
For low doses dilute to concentration not less than 1 microgram/mL
e.g. add 1 mL (4 micrograms) to 3 mL NS to give a concentration of 1 microgram/mL

Text should state: Add dose to 50 mL NS

 

Sodium chloride monograph, method column

Text currently states: Hyponatraemia or water intoxication:
(C) or (I) infusion via a central line

Text should state: Hyponatraemia or water intoxication:
(C) or (I) infusion

 

Sodium chloride monograph, dilution column

Text currently states: If not diluted the 1.8%, 2.7% and 5% solutions must be given via a central line. The solution may be diluted by co-administration with another fluid via a Y site

Text should state: The 1.8% solution may be given via a large peripheral vein.
If not diluted the 2.7% and 5% solutions must be given via a central line. The solution may be diluted by co-administration with another fluid via a Y site

 

Dalteparin monograph, comments column

Text currently states: (a) only the 10,000 units/mL ampoule and graduated pre-filled syringe are licensed for IV administration

Text should state: (a) only the 10,000 units/ 1mL ampoule and 100,000 units/4 mL vial are licensed for IV administration