Question

CASE STUDY A 45-year-old female patient with breast cancer is scheduled to have a venous access device implanted that will allow chemotherapy drugs to be administered without continual venipuncture. The procedure will be performed under local anesthesia with monitored anesthesia care. These are the medications listed on the surgeon's preference card: a. Xylocaine 1% plain in a 10-cc vial b. Heparin sodium 5000 units per mL-3 mL C. Heparin sodium 5000 units in 500 mL normal saline for injection d. Normal saline for irrigation-500 ml 1. Which medication is used to prevent the patient from feeling pain during the procedure? 2. What three items from the medication label must be verified when accepting medications onto the sterile field? 3. Which medication is considered the "dilute" heparin solution, and what is the concentration of that solution in units per ml? 4. Which medication is the "final flush" to assure that the device and its catheter are not occluded by a blood clot between uses, and what is the total amount of heparin (in units) of that solution? 5. What medication is used to counteract the effects of heparin sodium if too much is administered or the effects of heparin are no longer desired?

Answer 1

ANSWER.

1)a) Xylocaine is a local anestheticused to prevent the patient from feeling pain

       during the procedure.

2) Three items from the medication label should be verified includes.

                 1) Name of the drug.

                 2) Dosage strength.

                 3) Expiry date.

3) c) Heparin sodium 5000 units in 500 ml normal saline for injection is considered

        as the dilute heparin concentration.

           Concentration of this dilute heparin solution in units/ml = 5000/500

                                                                                                   = 10 units/ml.

4) b) Heparin sodium 5000 units per ml -3 ml is considered as the final flush.

               Total amount of units of that solution

                          Total ml of solution required = 3 ml

                          Units of heparin sodium in each ml = 5000 units.

                  So

                    Total amount of heparin in that solution = 5000 * 3

                                                                                = 15000 units.

5) Medication used to counteract the effect of overdose of heparin sodium is

   Protamine sulphate.