Selected items from the News and Latest Additions sections of www.palliativedrugs.com, the world’s leading palliative care website.
Safety updates
NPSA RRR: harm from flushing of nasogastric tubes before confirmation of placement
The UK National Patient Safety Agency (NPSA) has issued a Rapid Response Repost (RRR) following the deaths of two patients since 10 March 2011 where staff had flushed nasogastric tubes with water before initial placement had been confirmed.
Misplaced nasogastric tubes leading to death or severe harm are ‘never events’. The patient safety alert Reducing the harm caused by misplaced nasogastric feeding tubes in adults, children and infants was issued by the NPSA on 10 March 2011 with an action complete date of 12 September 2011. Alongside other actions, the alert requires all organisations to ensure that ‘Nasogastric tubes are not flushed, nor any liquid/feed introduced through the tube following initial placement, until the tube tip is confirmed by pH testing or x-ray to be in the stomach.’ The above guidance is applicable for all nasogastric tubes including those with water-activated lubricants. By the 21st September 2012, all organisations in the NHS and independent sector where nasogastric feeding tubes are placed for feeding patients are required to have implemented a series of action points, including the appointment of a named clinical lead and the education of staff. For more information click here.
Tolvaptan: rapid increase in serum sodium and risk of serious neurological events
The UK Medicines and Healthcare products Regulatory Agency (MHRA) has warned that treatment with tolvaptan (Samsca, Otsuka) can result in too rapid a correction of hyponatraemia, which can lead to serious neurological events. Specific advice is given for the monitoring of serum sodium, the acceptable rate of rise of serum sodium during treatment and that the co-administration of other drugs or fluids with a high sodium content (e.g. normal or hypertonic saline) is not recommended. They also warn that tolvaptan may reduce the effect of vasopressin analogues (e.g. desmopressin) used to control or prevent bleeding. For more information click here.
Risks of hypomagnesaemia and increased risk of fracture with long-term PPI use
The UK Medicines and Healthcare products Regulatory Agency (MHRA) have alerted health professionals of the possible risks of hypomagnesaemia and also increased fracture risk with long-term Proton Pump Inhibitor (PPI) use (generally >1year). For more information click here.
Prepared by Sarah Charlesworth and Andrew Wilcock