I am aware calcium gluconate is a vesicant but does dilution with 100ml of saline change the risk?
In an effor to make a "do not infuse" list for midlines, I am trying to explore the risks of administering calcium gluconate mixed in 100ml normal saline thru a midline that has blood return and no visible symptoms of complications ?(excludng ultrasound assessment).
My calculation: calcium gluconate Fresnius Kabi 6.8mOsm/10ml in 100ml normal saline 31 mOsm/100 would be 37.8mOsm/110mlx1000= 343 mOsm/L http://www.rxkinetics.com/iv_osmolarity.html
If pH is 6-8.2 and mOsm/L well below 900, is it ok to give thru funcitioning midline.?
Any thoughts on this are appreciated. I am working with Pharmacy as well.
Thank you,
Nancy
All calcium preparations for IV use are serious vesicants - on INS Red List. Yes dilution in any amount of fluid increases risk because 1) it will be on an infusion pump which keeps on pumping if there is an extravasation, no way pump can detect this, and 2) the nurse thinks they can walk away and leave it to infuse. Vesicants like this require assessment for blood return every 5 to 10 minutes and constant vigilance for lack of blood return and any hint of a patient complaint. Seen this far too many times in lawsuits. Calcium can be given by IV push with the nurse staying with the patient and doing the necessary blood return checks. And pH and osmolarity are not the issues. It is still a serious vesicant!
Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Our practice of diluting calcium should be changed to IVP. Excellent points, Lynn.
Nancy Rose