Peripheral administration of compounded calcium chloride is associated with a low incidence of IV infusion site reactions

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#IVTEAM #Intravenous literature: Anger, K.E., Belisle, C., Colwell, M.B., Dannemiller, R., Alawadhi, B., Wilkocki, A. and Szumita, P.M. (2013) Safety of Compounded Calcium Chloride Admixtures for Peripheral Intravenous Administration in the Setting of a Calcium Gluconate Shortage. Journal of Pharmacy Practice. December 10th. [epub ahead of print].

Abstract:

Calcium gluconate is preferred over calcium chloride for intravenous (IV) repletion of calcium deficiencies in the inpatient setting. In the setting of a national shortage of IV calcium gluconate, our institution implemented a compounded calcium chloride admixture for IV administration. The objective of this analysis is to evaluate the peripheral infusion site safety of compounded IV calcium chloride admixtures in adult inpatients. A total of 222 patients, encompassing 224 inpatient admissions, from April to June 2011 were retrospectively reviewed. Sterile preparations of calcium chloride in 5% dextrose (600 mg/250 mL and 300 mg/100 mL) were used during the study time period. Adverse infusion site reactions were assessed using an institutional infiltration and phlebitis grading system. A total of 333 doses were administered peripherally. In all, 4 (1.8%) patients experienced a moderate to severe infusion site reaction, with 3 due to phlebitis and 1 due to infiltration. Naranjo Nomogram for Adverse Drug Reaction Assessment classified all 4 reactions to have a possible link to calcium chloride administration. Peripheral administration of compounded calcium chloride admixtures in 5% dextrose is associated with a low incidence of IV infusion site reactions and can be considered as an alternative in the event of a calcium gluconate shortage.

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