In: Main31 Mar 2010
Safe Practice Recommendation:
Here are suggestions for avoiding errors in patients with hypernatremia:
Although the error cited in this article was not avoided, the use of sterile water in 2-liter (or larger) containers for IV compounding might facilitate alerting staff members as to its intended use. The difference in size also reduces the risk of confusing it with other 1-liter IV solutions. The hospital involved in this error has asked the manufacturers of Sterile Water for Injection, USP to place a warning label on both sides of the container.
The Institute for Safe Medication Practices (ISMP) has also found that the current labeling for sterile water products is inconsistent among the various manufacturers. Some containers boldly state, “Pharmacy bulk package. Not for direct infusion” within a red border; others simply state, “For drug diluent use only.”
The U.S. Pharmacopeia also requires a warning stating that these products are suitable for intravascular injection only after they are first made approximately isotonic by the addition of a suitable solute. However, this warning blends in with other label text and is not easily noticed.
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We are aware of additional cases of direct injection of sterile water and have therefore asked the Food and Drug Administration and manufacturers to place stronger, more visible warnings on all large-volume parenteral containers of this product.
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