Anaesthesia 2015, 70, 361–372
Correspondence Guaranteeing drug delivery in total intravenous anaesthesia Whilst reviewing the Safe Anaesthesia Liaison Group’s (SALG) 2009 recommendations Guaranteeing Dug Delivery in Total Intravenous Anaesthesia [1] in light of Kumar et al.’s paper [2], it concerned us that the ‘correct placement’ diagram (Fig. 1) recommends the inclusion of side-clamps in the drug delivery lines. There is an understandable need for a clamp on the intravenous fluid infusion line that only has an anti-reflux valve, as identified in correspondence by Drs Rutherford and Patri [2]. However,
we cannot identify the purpose of the clamps on the drug administration lines (which also incorporate anti-siphon valves). Accidental clamping of the drug administration line will interrupt drug delivery, increasing the risk of accidental awareness under general anaesthesia. With problems with TIVA-TCI pumps and intravenous lines common themes in SALG’s accompanying analysis of critical incidents, it seems counterintuitive to add additional complexity and an additional source of error to an already complex system. Patient safety and maintenance of anaesthesia are paramount and the use of dedicated TIVA-TCI drug administration sets is laudable, but such clamps appear
Intravenous infusion Anti-reflux valve Anti-siphon valves Clamp
Male luer lock
Triple connector
Drug A
Microbore siamese tubing Drug B Slide clamps
Figure 1 Correct placement diagram for guaranteeing drug delivery in total intravenous anaesthesia. Reproduced with permission from Safe Anaesthesia Liaison Group.
superfluous and we question their presence in national recommendations. We welcome a response from SALG or any manufacturer of such dedicated lines who may be able to allay our concerns on this matter. S. Denning M. Barley Queen’s Medical Centre, Nottingham, UK Email: [email protected] No external funding and no competing interests declared. Previously posted on the Anaesthesia correspondence website: www.anaesthesiacorrespondence.com.
References 1. Safe Anaesthesia Liaison Group. Guaranteeing Drug Delivery in Total Intravenous Anaesthesia. https://www.rcoa.ac.uk/ system/files/CSQ-PS-2-Safety-notificationTIVA.pdf (accessed 21/08/2014). 2. Kumar G, Stendall C, Mistry R, Kurusamy K, Walker D. A comparison of total intravenous anaesthesia using propofol with sevoflurane or desflurane in ambulatory surgery: systematic review and metaanalysis. Anaesthesia 2014; 69: 1138–50. 3. Rutherford J, Patri M. Failure of antireflux valve in a Vygon PCA set. Anaesthesia 2004; 59: 511–2. doi:10.1111/anae.12967
A response to a previously published article or letter must be submitted via the dedicated correspondence website at www.anaesthesiacorrespondence.com, following the guidance there and using the online form (not uploaded as a Word attachment). Please note that a selection of this correspondence will be reproduced (possibly in modified form) in the Journal. Correspondence on new topics should be submitted as an email attachment to [email protected]. Copy should be prepared in the usual style of the Correspondence section. Authors must follow the Guidance for Authors at wileyonlinelibrary.com/journal/anae, including completion and submission of an Author Declaration Form. © 2015 The Association of Anaesthetists of Great Britain and Ireland
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Correspondence Guaranteeing drug delivery in total intravenous anaesthesia Whilst reviewing the Safe Anaesthesia Liaison Group’s (SALG) 2009 recommendations Guaranteeing Dug Delivery in Total Intravenous Anaesthesia [1] in light of Kumar et al.’s paper [2], it concerned us that the ‘correct placement’ diagram (Fig. 1) recommends the inclusion of side-clamps in the drug delivery lines. There is an understandable need for a clamp on the intravenous fluid infusion line that only has an anti-reflux valve, as identified in correspondence by Drs Rutherford and Patri [2]. However,
we cannot identify the purpose of the clamps on the drug administration lines (which also incorporate anti-siphon valves). Accidental clamping of the drug administration line will interrupt drug delivery, increasing the risk of accidental awareness under general anaesthesia. With problems with TIVA-TCI pumps and intravenous lines common themes in SALG’s accompanying analysis of critical incidents, it seems counterintuitive to add additional complexity and an additional source of error to an already complex system. Patient safety and maintenance of anaesthesia are paramount and the use of dedicated TIVA-TCI drug administration sets is laudable, but such clamps appear
Intravenous infusion Anti-reflux valve Anti-siphon valves Clamp
Male luer lock
Triple connector
Drug A
Microbore siamese tubing Drug B Slide clamps
Figure 1 Correct placement diagram for guaranteeing drug delivery in total intravenous anaesthesia. Reproduced with permission from Safe Anaesthesia Liaison Group.
superfluous and we question their presence in national recommendations. We welcome a response from SALG or any manufacturer of such dedicated lines who may be able to allay our concerns on this matter. S. Denning M. Barley Queen’s Medical Centre, Nottingham, UK Email: [email protected] No external funding and no competing interests declared. Previously posted on the Anaesthesia correspondence website: www.anaesthesiacorrespondence.com.
References 1. Safe Anaesthesia Liaison Group. Guaranteeing Drug Delivery in Total Intravenous Anaesthesia. https://www.rcoa.ac.uk/ system/files/CSQ-PS-2-Safety-notificationTIVA.pdf (accessed 21/08/2014). 2. Kumar G, Stendall C, Mistry R, Kurusamy K, Walker D. A comparison of total intravenous anaesthesia using propofol with sevoflurane or desflurane in ambulatory surgery: systematic review and metaanalysis. Anaesthesia 2014; 69: 1138–50. 3. Rutherford J, Patri M. Failure of antireflux valve in a Vygon PCA set. Anaesthesia 2004; 59: 511–2. doi:10.1111/anae.12967
A response to a previously published article or letter must be submitted via the dedicated correspondence website at www.anaesthesiacorrespondence.com, following the guidance there and using the online form (not uploaded as a Word attachment). Please note that a selection of this correspondence will be reproduced (possibly in modified form) in the Journal. Correspondence on new topics should be submitted as an email attachment to [email protected]. Copy should be prepared in the usual style of the Correspondence section. Authors must follow the Guidance for Authors at wileyonlinelibrary.com/journal/anae, including completion and submission of an Author Declaration Form. © 2015 The Association of Anaesthetists of Great Britain and Ireland
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