Don’t use epidural tubing for an IV solution
From the January 17, 2008 issue
FLOLAN (epoprostenol sodium) is indicated for patients with primary pulmonary hypertension. The drug must be infused continuously through a dedicated central venous access device. It may not be interrupted for even a few minutes, as this may create life-threatening rebound effects due to the drug’s short half-life. Normally patients admitted to the hospital with this condition are already receiving the drug using an ambulatory infusion pump. However, some hospitals make it a policy to convert patients to their own standard infusion pump, which is already familiar to nurses and may employ important safety features such as dose-checking capabilities. Because the drug is incompatible with other intravenous medications, tubing used for Flolan administration sets should not have a Y connector for flushing the line or piggyback drug administration. Recently, we were surprised to hear that, for administration of Flolan, a hospital was using Hospira Plum infusion pumps and administration sets typically used for epidural solutions. While the epidural administration set has no Y connectors, the yellow stripe running through the length of the tubing is widely recognized as being used for epidural tubing. Indeed, the tubing package, while labeled as a “Primary I.V. Plumset,” also has a yellow label in the package stating “Epidural Line Only” (see Figure 1). Because of the danger of confusing an IV line as an epidural line, yellow striped tubing should never be used for anything other than an epidural infusion. Plum administration sets without Y connectors, and without a yellow stripe, are available from Hospira. (When Flolan is dispensed from the pharmacy, the correct tubing could be sent with the product.) We’ve contacted Hospira about the potential for confusion, as the labeling mentions both IV and epidural use for what is universally accepted as epidural tubing. The company reported it would look into the matter.
Figure 1. Fluid administration set package label (L) mentions “IV,” but the package itself
contains yellow striped tubing and label stating “Epidural Line Only” (R)