Sux in the IV line

The patient developed marked laryngospasm after extubation and was given 25mg of suxamethonium (via the anti-reflux valve of the IV cannula - no IV fluids running). Later back in the ward the nurse gave an IV dose of granisetron for nausea. The patient suffered a respiratory arrest. Though the patient made a full recovery they had total recall for the event which was highly distressing.

 

 

Comment 1

The dead space of a 20G IV cannula with an anti-reflux valve attached is 0.2 mls, which equates to 10 mg of suxamethonium. As anaesthetists we need to flush IV lines and in situ canulas with saline after administering suxamethonium, or other muscle relaxants or potent vaso-active drugs.

Comment 2

We need to have an awareness of this potential risk which can lead to this serious complication. The IV line or bung or reflux valve should be flushed immediately following injection of suxamethonium or other muscle relaxant.

Comment 3

Our Medical Indemnity Organisations advise us to speak with the patient and their relatives as soon as possible after an adverse event such as this. You do not have to admit fault, but you do to need to convey to the patient and relatives that you take this complication very seriously and will look closely at all the possible predisposing factors and endeavour to ensure that you will minimise the risk of this happening to future patients.