Purple is Not an Official Standard for Either Enteral Feeding Equipment or PICC Lines

An epileptic patient who was supposed to receive oral KEPPRA (levetiracetam) liquid via a PEG tube instead received it IV via a Bard PowerPICC (peripherally inserted central catheter) line. This catheter is indicated for short or long-term peripheral access to the central venous system for intravenous therapy, power injection of contrast media, central venous pressure monitoring, and blood sampling. An oral Baxa amber syringe that held the levetiracetam did not connect properly to the hub of the PICC line, however it could be held easily against the opening for the injection. The patient was closely monitored by his medical team and, fortunately, did not have a negative outcome.

It’s possible that the experienced nurse who incorrectly gave the drug IV was confused by a purple color system available from Covidien for enteral feeding equipment. The color is identical to the purple coloring used for the patient’s Bard PowerPICC line (see Figure 1).

Purple is not an official standard color for either enteral products or PICC lines in the US, although it is the official color for enteral products in the United Kingdom. The concern is the identical color for both enteral and vascular lines, which may increase the risk of wrong connections. Even though the enteral connectors don’t easily fit into a vascular catheter’s Luer, it is possible that a determined individual will make it work, as happened here. Even more confusing is that some enteral products utilize orange as the color on some enteral feeding equipment and some PICC lines are also orange. Other manufacturers may also have purple PICC lines; likewise, other purple enteral products may become available.

Avoid using the same color for each type of access device.

Also, adding a stronger auxiliary label—For Oral Use Only—might help. The syringe used in the error cited above has “oral use only” imprinted in small font that is easily missed. The syringe label from pharmacy also had small type stating, “oral use only,” but the nurse saw neither. The hospital is now getting special tamper-proof labels with “ORAL” in large case, which they plan to apply over the syringe cover so it’s visible to the nurse. They have also stepped up orientation efforts to brief nurses on the risk of error. It would be helpful if FDA stepped in to help standardize the colors for these products.