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Rockville, MD: Agency for Healthcare Research and Quality; October 2022.
This case describes a 20-year-old woman was diagnosed with a pulmonary embolism and occlusive thrombus in the right brachial vein surrounding a peripherally inserted central catheter (PICC) line (type, gauge, and length of time the PICC had been in place were not noted). The patient was discharged home but was not given any supplies for cleaning the PICC line, education regarding the signs of PICC line infection, or referral to home health services.
This WebM&M describes two cases involving patients who became unresponsive in unconventional locations – inside of a computed tomography (CT) scanner and at an outpatient transplant clinic – and strategies to ensure that all healthcare teams are prepared to deliver advanced cardiac life support (ACLS), such as the use of mock codes and standardized ACLS algorithms.
Farnborough, UK: Healthcare Safety Investigation Branch; February 17, 2022.
ISMP Medication Safety Alert! Acute care edition. February 10, 2022:27(3):1-6.
Allen LV, Jr. Int J Pharm Compd. 2021;25:131-139; 222-229.
ISMP Medication Safety Alert! Acute care edition. 2021;26(13);1-2.