8 Special situations Q8.1 How should labels be applied in an emergency? The Labelling Standard should be applied in all situations as far as practically possible. However, it is not always practical to identify injectable medicines according to the Labelling Standard when the patient and health professionals may be in an immediate situation. Labels designed for use on syringes used during anaesthesia, as per the Anaesthetic Labelling Standard, may be considered to identify the medicine contained in syringes. The following situations are exempt from labelling in all circumstances, including emergency: when a single person draws up and immediately administers a medicine without the syringe leaving the hand when fluid bags used for infusion do not have any additional injectable medicines added before administration, such as IV fluids (e.g. 0.9% sodium chloride, 5% glucose) or premixed solutions (e.g. potassium, heparin infusion bags). Use of preprinted active ingredient labels, consistent with the Anaesthetic Labelling Standard, may be suitable for ambulance services. However, these are not suitable if the patient identity needs to be recorded. Q8.2 What labelling is required in renal dialysis? Dialysis catheters should be labelled with the ‘Catheter lock’ label to identify the medicine in the catheter. This includes a renal dialysis catheter used for haemodialysis. Catheter lock label The dialysis catheter is generally ‘heparin locked’ to maintain patency. Any medicine in the dialysis catheter lock must be removed before use. There is a potential risk of infusing heparin in large doses, resulting in over-anticoagulation, if heparin is not removed from the lock before dialysis. Alteplase may be used as an alternative to heparin to maintain patency. Other medicines may be introduced into the dialysis catheter, including antibiotics and urokinase. 8.2.1 Should syringes containing medicines for haemodialysis cannulation be labelled? Commonly, sodium chloride and lignocaine are used during the cannulation procedure. This procedure follows the principles of aseptic technique.
8 Special situations Q8.1 How should labels be applied in an emergency? The Labelling Standard should be applied in all situations as far as practically possible. However, it is not always practical to identify injectable medicines according to the Labelling Standard when the patient and health professionals may be in an immediate situation. Labels designed for use on syringes used during anaesthesia, as per the Anaesthetic Labelling Standard, may be considered to identify the medicine contained in syringes. The following situations are exempt from labelling in all circumstances, including emergency: when a single person draws up and immediately administers a medicine without the syringe leaving the hand when fluid bags used for infusion do not have any additional injectable medicines added before administration, such as IV fluids (e.g. 0.9% sodium chloride, 5% glucose) or premixed solutions (e.g. potassium, heparin infusion bags). Use of preprinted active ingredient labels, consistent with the Anaesthetic Labelling Standard, may be suitable for ambulance services. However, these are not suitable if the patient identity needs to be recorded. Q8.2 What labelling is required in renal dialysis? Dialysis catheters should be labelled with the ‘Catheter lock’ label to identify the medicine in the catheter. This includes a renal dialysis catheter used for haemodialysis. Catheter lock label The dialysis catheter is generally ‘heparin locked’ to maintain patency. Any medicine in the dialysis catheter lock must be removed before use. There is a potential risk of infusing heparin in large doses, resulting in over-anticoagulation, if heparin is not removed from the lock before dialysis. Alteplase may be used as an alternative to heparin to maintain patency. Other medicines may be introduced into the dialysis catheter, including antibiotics and urokinase. 8.2.1 Should syringes containing medicines for haemodialysis cannulation be labelled? Commonly, sodium chloride and lignocaine are used during the cannulation procedure. This procedure follows the principles of aseptic technique.