GovWire

Review of glucose solutions in arterial lines

Flush fluids are used to maintain the patency of arterial lines when used for the continuous monitoring of blood pressure. The selection and attachment of the wrong flush fluids to arterial lines is a recognised risk and incidents of serious clinical harm have occurred as a result.^{[footnote 1] [footnote 2] [footnote 3] [footnote 4]} When the flush fluid contains glucose and a blood sample is taken from the arterial line, the sample can be contaminated with the glucose from the solution and generate a falsely high blood glucose reading, even after discarding several dead volumes of the fluid. This can result in the inappropriate administration of insulin to the patient and potentially fatal hypoglycaemia.

Discarding dead volume fluid is not sufficient to prevent blood contamination following the use of glucose in the flushing system. When drawing blood samples from patients receiving 5% glucose solution in their flush systems, a discard equal to 5 times the dead space did not prevent clinically significant sample contamination in an open arterial system in a study comparing the performance of three closed system arterial line transducer sets with their partner open systems. ^{[footnote 5]}

The National Patient Safety Agency issued a rapid response report to highlight these risks in 2008.3 The MHRA conducted a review of the risks associated with inappropriate flush fluid use and subsequently published a Drug Safety Update article in July 2012 (republished in 2014).

More recently, the Healthcare Safety Investigation Branch (HSIB) highlighted the importance of using the appropriate flush fluid in its report published in 2022. Following this HSIB report, we want to remind healthcare professionals about this risk and note that the use of pressure infusion bags with clear panels provides an additional layer of risk mitigation against use of an incorrect flush fluid by enabling users to easily check the label.

Report suspected reactions and medication errors

Please continue to report suspected adverse drug reactions to the Yellow Card scheme.

Healthcare professionals, patients, and caregivers are asked to submit reports using the Yellow Card scheme electronically using:

• the?Yellow Card website
• the Yellow Card app; download from the?Apple App Store?or?Google Play Store
• some clinical IT systems for healthcare professionals (EMIS, SystmOne, Vision, MiDatabank, and Ulysses)

When reporting, please provide as much information as possible, including information about batch numbers, medical history, any concomitant medication, onset timing, treatment dates, and product brand name.

Article citation: Drug Safety Update volume 16, issue 10: May 2023: 2.