|All admixtures are to have 1 gm of Na Thiosulfate added per 100 mg of
Nitroprusside to prevent cyanide toxicity.
Cyanide and thiocyanate levels are recommended to
monitor for cyanide toxicity in patients who are not receiving concurrent
thiosulfate. Note: Cyanide and thiocyanate toxicity are two
Thiocyanate levels are recommended for patients
receiving nitroprusside with thiosulfate. Note: Thiosulfate prevents toxic
cyanide levels even at high nitroprusside infusion rates.
Nitroprusside infusion of 2-5 mcg/kg/min may give
toxic thiocyanate levels in:
7-14 days in patients with normal renal function
3-6 days in renal failure, unless they are
receiving concurrent dialysis. Thiocyanate clearance rates during dialysis
approach the blood flow rate of the dialyzer.
Nitroprusside Mixing and Covering to Increase Stability, P&T Review
Nitroprusside will only be mixed in Dextrose 5%.
Stability is reduced in 0.9% NaCl.
Nitroprusside / thiosulfate admixtures will be placed
inside of a plastic light protective bag. This will ensure that the top
of the admixture is protected from light.
The top of the light protective bag will be taped to
prevent light from entering from above through the hanger hole.
The bottom of the light protective bag will either be
cut off or rolled up to expose the port.
Nitroprusside exposure to light experiment
The pictures were taken at hourly intervals starting at 10:45 am for images
1-9, 11 was taken the follow morning at 8am, and hourly until image 14.
Fluorescent lighting in the pharmacy, incandescent lighting at home (wooden
table pictures). I took the bags home over night so I could continue taking
pictures and brought them back to work in the am.
Key: N (100 mg nitroprusside), T (1 g sodium thiosulfate) all in Dextrose 250
The bag on the far left has 100 mg ntiroprusside and 1 g of sodium
The bags of the left were uncovered through out the experiment. Those on the
right were uncovered for the pictures and immediate recovered with a black over
A color change was apparent after 2 hours. The intense blue color disappeared
over the weekend while the uncovered bags were exposed to light.
I have sent all information to Lawrence A Trissel and ASHP for their review
We will be purchasing tubing covers for IV sets.