Administering D50

[Dustdevil]

Before, during, and after? LOL...

So what, you get aspiration but ignore that big bump appearing at the site until you suddenly can't aspirate after you gave the drug? Silly...

You are constantly evaluating the site, aspiration is simply one way...

Doesn't always work that way. I have had serious extravasational complications from D50 without the vein every "blowing" in grand fashion. In fact, the IV remained patent the whole time.

I have heard of the aspiration technique somewhere along the line before. Probably in nursing clinicals. But I admit to not utilising it regularly. It is certainly a good idea though. Just one more check in the process to potentially save you from harming your patient. Used in conjunction with slow administration (too many excited medics try to slam D50) and frequent flushing, I think it can go a long way towards lessening the side effects of D50 administration.

[iMac]

I dont understand why you would do it. Im from Alberta and did give the drug once a few years back when I was on practicum. I have never seen anyone do it or even heard of it prior to this post. To me it doesnt make sense.

I would hope especially with a drug like that you would make sure you had a good line before administering it. Its not that complicated. Pay close attention to your line during administration and give it a good flush afterwards :wink:

[FireMedic47]

Hey all Im a newbie here but not a newbie to EMS.......In my 4 years as a medic i have never heard of this rule. I wouldn't agree with this rule either. A job that i once worked required a blood draw of one gray top tube with a suspected diabetic patient. Many times I have started an 18 gauge in the AC to have it hit a valve, so my theory to this is, if you can't aspirate it back because your teflon catheter is occlude by a valve that only allows foreward flow through the catheter...do you call it a bad line? I ve always given D50 Slow IVP with a finger over the cathether so i would feel any infiltration. I think it is an unneccessary rule to aspirate 3 times.

[Dustdevil]

...so my theory to this is, if you can't aspirate it back because your teflon catheter is occlude by a valve that only allows foreward flow through the catheter...do you call it a bad line?

Yes. The alternative is to place my patient in jeopardy because I am too lazy to start a second IV.

It's a no-brainer.

I admire your technique, but if you could do better, why wouldn't you?

[FireMedic47]

by no means would i want to jeapordize my patient but when i know i have a patent line after flushing 2-10 cc saline flushes through with no infiltration or difficulties, and the Blood sugar is 11 mg/dL.......Im satisfied that if it is flushing without problems or infiltration then it will work just as well as a second IV.

It was kind of a mixed scenerio for me when it happened because with an EMT partner, and no backup anywhere closeby, priority was to fix the problem that presented as quickly as possible before it got worse. The patient was darn near buying a tube and probably indicated for an airway, i chose to see if the D50 would help before the patient bought a Tube and then had to wake up. Luckily i chose right treatment path because the patient improved to a GCS of 13 from an initial 3.....

I know every medic here treats a situation differently and im not trying to argue with anyone. I love to debate medical issues and things of such nature, thats why i believe i will like this place! Thanks for all the insight!!!

PLus i like to add

[Dustdevil]

Yeah... you are correct that each and every situation comes with it's own set of priorities.

I would be the last person here to ever say that there are too many "always" rules in EMS.

[FireMedic47]

I agree totally!

[EMT/S31]

Ah one of my favorite drugs D50. Well I cant say that I was taught to aspirate but I do see the reason for doing it. Although I would much rather check with a NaCl flush, we carry the predosed jets which would make this very difficult.

[ManchesterEMT]

on one of my on-road practicums...i saw an ER doc squirt the D50 into a cup and get the patient to drink it

You think thats bad??? I work part-time as a phleb at our local trauma center. I once saw a rural service bring in a pt. who had been given D50 via his ET tube!

[IN2B8]

Don’t aspirate 3 times but do a 10cc flush NS to make sure the line flushes good before administration of the D50. If you can only get a 22ga. you can dilute the D50 to D25 and it will flow thru a smaller ga. easier. I always believed that you had to have a large IV to give D50, but I was working with a medic of over 20 years and she gave it thru a 20ga. and I thought that the Pts. arm was going to fall off. Not the case she sad she had given it this way for years w/o any problems just have to push it slow. Also when you give it do you hang NS or D5W? .

Has anyone given D50 thru a adult IO? Is this possible?

Does everyone carry Glucagon as a backup?

What would be wrong with pulling 50cc out of a 250 bag of D5W and putting the D50 in and using a ten gtts. set, and giving it that way thru something as small as a 22-24ga. Just keep good check on BS and shouldn’t be a problem, it may take a few min. but the Pt. is getting the meds.

CW