Glucose solutions: recommendations to minimise the risks associated with the accidental use of glucose solutions instead of saline solutions in arterial lines

We remind healthcare professionals that accidental use of glucose-containing solutions as flush fluid for arterial lines may contaminate blood samples and result in falsely high glucose readings. This may lead to inappropriate insulin administration and subsequent hypoglycaemia. Healthcare professionals should use saline solutions to flush arterial lines and use pressure infusion bags with transparent windows to ensure that the fluid label is visible at all times.

From:
Medicines and Healthcare products Regulatory Agency
Published
25 May 2023
Therapeutic area:
Anaesthesia and intensive care, Endocrinology, diabetology and metabolism

Advice for healthcare professionals:

  • do not use glucose-containing solutions for continuous blood pressure monitoring via arterial lines
  • only saline (0.9% sodium chloride) infusions should be used as the flush solution for arterial lines to minimise the risk of incorrect blood glucose readings and inappropriate insulin administration
  • use pressure infusion bags with clear panels to ensure that the fluid label is visible at all times
  • report suspected adverse drug reactions associated with glucose solutions on a Yellow Card
  • report medication errors or near misses via local risk management systems and medication errors resulting in patient harm on a Yellow Card

Review of glucose solutions in arterial lines

Flush fluids are used to maintain the patency of arterial lines when used for the continuous monitoring of blood pressure. The selection and attachment of the wrong flush fluids to arterial lines is a recognised risk and incidents of serious clinical harm have occurred as a result.[footnote 1] [footnote 2] [footnote 3] [footnote 4] When the flush fluid contains glucose and a blood sample is taken from the arterial line, the sample can be contaminated with the glucose from the solution and generate a falsely high blood glucose reading, even after discarding several dead volumes of the fluid. This can result in the inappropriate administration of insulin to the patient and potentially fatal hypoglycaemia.

Discarding dead volume fluid is not sufficient to prevent blood contamination following the use of glucose in the flushing system. When drawing blood samples from patients receiving 5% glucose solution in their flush systems, a discard equal to 5 times the dead space did not prevent clinically significant sample contamination in an open arterial system in a study comparing the performance of three closed system arterial line transducer sets with their partner open systems. [footnote 5]

The National Patient Safety Agency issued a rapid response report to highlight these risks in 2008.3 The MHRA conducted a review of the risks associated with inappropriate flush fluid use and subsequently published a Drug Safety Update article in July 2012 (republished in 2014).

More recently, the Healthcare Safety Investigation Branch (HSIB) highlighted the importance of using the appropriate flush fluid in its report published in 2022. Following this HSIB report, we want to remind healthcare professionals about this risk and note that the use of pressure infusion bags with clear panels provides an additional layer of risk mitigation against use of an incorrect flush fluid by enabling users to easily check the label.

Report suspected reactions and medication errors

Please continue to report suspected adverse drug reactions to the Yellow Card scheme.

Healthcare professionals, patients, and caregivers are asked to submit reports using the Yellow Card scheme electronically using:

When reporting, please provide as much information as possible, including information about batch numbers, medical history, any concomitant medication, onset timing, treatment dates, and product brand name.

Article citation: Drug Safety Update volume 16, issue 10: May 2023: 2.

  1. Sinha S and others. Fatal neuroglycopaenia after accidental use of a glucose 5% solution in a peripheral arterial cannula flush system. Anaesthesia 2007: volume 62, pages 615 to 620. ↩

  2. Panchagnula U, Thomas AN. The wrong arterial line flush solution. Anaesthesia 2007: volume 62. Pages 1077 to 1078. ↩

  3. Hill K. New guidance issued following problems with infusions and sampling from arterial lines. BACCN Nursing in Critical Care 2008: volume 13, page 318. ↩

  4. Healthcare Safety Investigation Branch (HSIB), 2022. The use of an appropriate flush fluid in arterial lines. ↩

  5. Brennan KA and others. Reducing the risk of fatal and disabling hypoglycaemia: a comparison of arterial blood sampling system. British journal of Anaesthesia 2010: volume 104, pages 446 to 451. ↩

Published 25 May 2023
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