Friday August 11, 2006
Drug bug !

Intensivists should have full command of any drug, its concentration and its infusion protocols, that is ordered in ICU. If some rules are followed, there is little chance that you will make a mistake. For example

Do you know the standard ratio solution?

Ratio solution express the number of grams of the drug per total millilitres of solution.
(Note: This is NOT mg to ml but gram to mls - got it?)

Example:

· Epinephrine 1:1000 contains 1 gram 'pure drug' per 1000 mL of solution.

means
1 gm : 1000 mL or
1000 mg : 1000 mL or
1 mg : 1 mL
- but always written as gram : millilitres

- drug bug?

Thursday August 10, 2006
Level of central line tip may predispose to thrombosis

Interesting retrospective review of 428 central lines (inserted into 334 patients) was done in UK to look into the level central line tip's relation to thrombosis 1. The median follow-up was 72 days.

* The chest radiograph obtained post-catheter insertion, as well as follow-up radiographs, linograms, venograms and Doppler ultrasounds (US), were reviewed.

They found that: "There was a significant difference in thrombosis rate between lines sited with the tip in a distal third of the superior vena cava (2.6%) compared with a proximal third of the superior vena cava (41.7%) - CVC with tips in a proximal position were 16 times more likely to thrombose than those in a distal position".


Related previous pearls:

1. CXR reading for optimum tip of central line
2. What if SC central line ends up in IJ vein?
3. Peres-nomogram

Reference:
1. To clot or not to clot? That is the question in central venous catheters - Clinical Radiology, Volume 59, Issue 4, April 2004, Pages 349-355