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- Care Trusts
- Mental Health Trusts
- Specialists Trusts
- NHS Regional Offices
- Learning Disabilities Trusts
- Mental Health & Social Care Trusts
- Ambulance Trusts
- Mental Health & Learning Disabilities Trusts
- Acute Trusts
- Community Trusts
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- Other contacts
- Independent Healthcare Providers (registered with CAS)
- Clinical Commissioning Groups
- Special Health Authorities
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Title: |
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Risk of death or severe harm from inadvertent intravenous administration of solid organ perfusion fluids
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Broadcast content: |
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Perfusion fluids are
mainly used during solid organ transplantation procedures to perfuse and
preserve organs. If inadvertently intravenously administered to a patient, the
high potassium content of some perfusion fluid can cause cardiac arrest.
Patient safety incidents have been
reported where there has been confusion between solid organ perfusion fluids and other fluids
intended for administration to
patients.
To prevent this risk hospitals with transplant units are asked to ensure that storage of organ
perfusion fluids is reviewed to reduce the chance of confusion with other
fluids intended for administration to patients. Other hospitals are asked to
remove all solid organ perfusion fluids from clinical areas.
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Additional information: |
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Regional teams - this alert does not need to be cascaded to primary care.
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Action underway deadline: |
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20-Apr-2018
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Action complete deadline: |
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31-May-2018
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