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The practitioner must check each monograph before deciding which flush to use buy red viagra 200 mg otc erectile dysfunction caused by high cholesterol, to ensure that both drugs are compatible with the chosen flush buy 200mg red viagra with mastercard erectile dysfunction 24. Frequent flushing of unused lines is also necessary in order to maintain patency of the line or cannula. The National Patient Safety Agency has recently recommended the exclusive use of NaCl 0. If the use of a heparin flush is appropriate then it must be administered against a valid prescription. Practitioners should check their individual organisation’s policies in order to determine when the use of a heparin flush is appropriate. Central versus peripheral access Before a medicine can be administered intravenously, a suitable intravenous catheter must be inserted into the patient. Choice of line is often dictated by the clinical condition of the patient; for example, a critically ill patient is more likely to require central access than a patient who only requires a few days’ intravenous therapy. Unlike peripheral catheters, central lines are generally thought to last longer, are more consis- tently accessible regardless of the patient’s condition and can accept more irritant solutions, e. Central catheters also carry the advantage of allowing a rapid rate of infusion of a drug and can be used to monitor central venous pressures as well as aid the passing of pulmonary artery catheters. However, insertion of central intravenous catheters requires greater skill and the risks associated with them are greater. Central and peripheral catheters are often referred to in the vernacular as central lines and peripheral lines. The term glucose (abbreviated to Gluc in this book) is used throughout the monographs to define the injection and infusion fluid of that substance. The term dextrose is used by some authorities and on occasion this been known to lead to confusion. Glucose is a three-dimensional molecule that exists in two symmetrical forms (mirror images of each other) and the dextro-andlaevo- prefixes are used to categorise the forms that can rotate plane- polarised light clockwise (to the right) or anticlockwise (to the left) respectively. The word dextrose is a contraction of dextrorotatory glucose or d-glucose, which is the biologically active form of glucose, as opposed to laevorotatory glucose or l-glucose (which is not biologically active). It is however structurally different from glucose and is not the laevorotatory form of glucose. Osmolarity Osmolarity is stated in some monographs only for those drugs that have a high osmolarity. The significance of this is that at a solution of high osmolarity can cause serious harm to small blood vessels and these drugs would not normally be appropriate for peripheral administration. It is worth explaining what the term means and how it differs from the similar term osmolality. Osmolarity is a measure of solute concentration in terms of osmoles per litre of solution (Osmol/L), whereas osmolality is a measure of the number of osmoles of solute per kg of solvent (Osmol/kg). Calculated figures for both are very similar and the terms are used interchangeably in practice with little consequence. An osmole (Osm or Osmol) is a unit of measure that describes the number of moles of a chemical compound that contribute to a solution’s osmotic pressure, that is, the pressure that must be applied to a solution to prevent the inward flow of water across a semi-permeable membrane. A ppendix 2 G ood m anagem ent principles It is unacceptable to prepare medicines for administration by others. The practitioner administering the drug must be involved in the preparation and checking process. The following are exemptions from this principle: * Injections and infusions prepared by the Pharmacy department. Parenteral drugs must not be prepared in advance of their immediate use (except when prepared by the Pharmacy). Parenteral medicines do not routinely need to be double-checked by another practitioner; however, each practitioner should check their own organisation’s policy on this matter before administering a medicine.

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