Be careful where you inject these!
From the May 6, 2004 issue
While preparing for a cataract procedure, an OR nurse
went into the refrigerator to obtain sodium hyaluronate.
She quickly noticed two different products. One was sodium
hyaluronate 10 mg/mL (HEALON), manufactured by Pharmacia;
the other was sodium hyaluronate 20 mg/ 2 mL (HYALGAN),
manufactured by Sanofi-Synthelabo. The nurse looked at each
product and realized that they were the "same"
medication (sodium hyaluronate) in the same concentration
(see photo), so she decided to use Hyalgan for the cataract
case. However, as soon as the surgeon began using the product,
he immediately noticed that the fluid was much different
in viscosity than what he typically used. He withdrew what
he had just injected and asked for Healon instead. The surgery
was completed and the patient fared well.
Although both products contain the same basic chemical,
Hyalgan is designed for injection into joints. It is typically
used to treat pain and help restore normal joint function
in osteoarthritis where the elastoviscous properties of
the synovial fluid in the knee joint diminish, resulting
in less protection and shock absorption. Healon is a viscoelastic
used as a surgical aid in cataract extraction and intraocular
lens implantation. It is also indicated for use in glaucoma
filtration and posterior segment procedures. On the side
of the Healon carton is a note stating that the product
is intended for ophthalmic use. The carton of a similar
product, AMVISC, has such a notation, but it also
has a large picture of an intraocular injection, clarifying
its intended use. Hyalgan does not state the purpose of
the drug on the outside carton.
To prevent dispensing errors in facilities where both products
are available, add an auxiliary label to the cartons to
remind staff about each drug's indication (ophthalmology