D5W

[Spock]

Very interesting topic which sent me to my pharmacology texts and the ACLS manual. The reason being is we mix amiodarone with normal saline for an infusion as per our protocols. We do not carry D5W in the ambulance. Our drug boxes are sealed so when we use one we replace the entire box at the hospital and pharmacy refills it. The medical directors eliminated D5W a few years ago for simplicity. I also mix amiodarone in NSS in the hospital and have never seen it precipitate and the desired effect was achieved. If fact, we mix all infusions (epi, norepi, neosynephrine, dobutamine, milrinone etc.) in NSS in my hospital.

I could find nothing in the pharm text about D5W vs. NSS and the ACLS text said either was ok. In fact, I have been teaching in the ACLS class for 5 years that you mix it in NSS. I really don't think it matters but fascinating nonetheless.

You guys are the best because you challenge the envelope and strive to improve. Keep it up. The future of EMS is bright!

Live long and prosper.

Spock

[AZCEP]

I may have mentioned it earlier in the thread, but the biggest reason not to mix Amiodarone yourself is the need for a "special" container. The short term management doesn't present a problem, but over the longer period, the amount of drug that is lost, and the amount of plastic that is added to the solution becomes a more important concern.

The typical mixing bag of 50-100 mL of NS, probably isn't going to create an issue of Na+ or Cl- overload in the 10-15 minutes it takes to finish the infusion. Over a couple of days it may, but again probably not if there is any semblance of functioning kidneys.

For the most part we try not to mix the drug at all, just push real slowly. A good guide, I've found, is pushing the 150 mg dose slowly enough that the 10 gtt/mL drips don't stop during your pushing. Timed it out once, and it came out to about 11 minutes.

Feel free to try it sometime.

[Spock]

I like the idea of the slow push and it makes sense. I'll try it next time even though the prehospital coordinator will say I violated protocol. Well that wouldn't be the first time.

Good point about the special container. Our premixed amiodarone comes in a special plastic IV bag similar to insulin.

Live long and prosper.

Spock

[vs-eh?]

We mix 150mg amiodarone in a 30ml syringe with normal saline and push it over ten minutes...

[Spock]

150mg in 30cc saline is in the AHA ACLS text but I'm not sure why that isn't done more often because it might be easier than an infusion.

Live long and prosper.

Spock