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Methemoglobinemia Facts / Tips
At our GI Nurses and Associates Day Event at South Pointe, one of the questions brought up to the panel was regarding the use of benzocaine sprays and the risk of Methemoglobinemia. The point was brought up that we should all have Methylene Blue in our Emergency drug boxes. Below is a label that Karen Sudbury RN, CGRN from Parma Community General Hospital sent to me to share. This is the label that they have on their drug boxes at PCGH. She also submitted a few tips that are listed below the label. We thank Karen and Parma Hospital for their generous sharing of information. Before adapting for your own use, be sure to check with your Pharmacy staff to get their approval and input.

Sample label for drug box:

METHEMOGLOBINEMIA

Treatment:
- AIRWAY MANAGEMENT: 100% O2, intubation, ventilation
- METHYLENE BLUE: 1-2mg/kg (0.1-0.2ml/kg) 1 % solution IV over 5 min.;repeat dose (1mg/kg) if patient is symptomatic after 30 min. or methemoglobin level is more than 30%
- OTHER: Gastric lavage, activated charcoal, cathartics, exchange transfusion, hyperbaric oxygen, pressors, anticonvulsants
Diagnosis:
- Methemoglobinemia levels, co-oximetry, ABG,CBC, SMA-7
Key Points:
- Clues: Central cyanosis unresponsive to 100% O2, "sat gap" (disparity between calculated and measured O2 saturation), pulse oximetry inaccurate

Some additional information: Get Met Hgb. Level from ABG

Signs and Symptoms: at some point during or immediately after EGD,TEE etc. after using a benzocaine spray, patient’s O2 sat. drops and is not responsive to increasing O2 being administered. Lips and nail beds are blue, but patient does not look to be in any distress.

After giving Methylene Blue dose, O2 sat drops even further, then slowly begins to rise. Cyanosis improves. Urine becomes blue.

We thank Karen and Parma Hospital for sharing this information with us.

Colon Cancer Support Group
Meets at The Gathering Place, which is located in The Arnold and Sydell Miller Family Campus at 23300 Commerce Park, Cleveland, Ohio 44122. For more information phone (216) 595-9546 or visit www.touchedbycancer.org. The group meets the first Thursday of each month from 7:00-8:30 PM. Please pass this information on to your patients, family or friends who may be affected by Colon Cancer.

Scope Theft
There have been many incidents of scope theft throughout area hospitals. You may want to evaluate how well your unit is securing your valuable equipment. Lock scope cabinets, lock units, limit access. Consult your security department for ideas of how to make your equipment more secure.

Website Provided By:

IMS - Integrated Medical Systems International, Inc.
www.imsready.com


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NCOSGNA Regional Society Officers President Michelle Older RN, BSN gm_gb@hotmail.com President-Elect Amy Macak RN, CGRN Past-President Jim Collins RN, CNOR collinj@ccf.org Treasurer Amy Johnson RN, CGRN amyjcgrn@aol.com Secretary Cindy Mathias GTS cynthiakmathias@hotmail.com Board Members Mary Ellen Geraghty Linda Smith Delegate Debbie Luteran RN, CGRN jluter@aol.com Alternate Delegate Carol Fox, RN Vendor Liason Sylvia Vielhaber RN Ways and Means Linda Assad LPN LMA228@aol.com Newsletter Editor Mary Ellen Geraghty RN, BSN, CGRN Education Committee: Jim Collins RN, CNOR Cheryl Simpson RN Linda SMith RN, CGRN	NCOSGNA News Methemoglobinemia Facts / Tips At our GI Nurses and Associates Day Event at South Pointe, one of the questions brought up to the panel was regarding the use of benzocaine sprays and the risk of Methemoglobinemia. The point was brought up that we should all have Methylene Blue in our Emergency drug boxes. Below is a label that Karen Sudbury RN, CGRN from Parma Community General Hospital sent to me to share. This is the label that they have on their drug boxes at PCGH. She also submitted a few tips that are listed below the label. We thank Karen and Parma Hospital for their generous sharing of information. Before adapting for your own use, be sure to check with your Pharmacy staff to get their approval and input. Sample label for drug box: METHEMOGLOBINEMIA Treatment: AIRWAY MANAGEMENT: 100% O2, intubation, ventilation METHYLENE BLUE: 1-2mg/kg (0.1-0.2ml/kg) 1 % solution IV over 5 min.;repeat dose (1mg/kg) if patient is symptomatic after 30 min. or methemoglobin level is more than 30% OTHER: Gastric lavage, activated charcoal, cathartics, exchange transfusion, hyperbaric oxygen, pressors, anticonvulsants Diagnosis: Methemoglobinemia levels, co-oximetry, ABG,CBC, SMA-7 Key Points: Clues: Central cyanosis unresponsive to 100% O2, "sat gap" (disparity between calculated and measured O2 saturation), pulse oximetry inaccurate Some additional information: Get Met Hgb. Level from ABG Signs and Symptoms: at some point during or immediately after EGD,TEE etc. after using a benzocaine spray, patient’s O2 sat. drops and is not responsive to increasing O2 being administered. Lips and nail beds are blue, but patient does not look to be in any distress. After giving Methylene Blue dose, O2 sat drops even further, then slowly begins to rise. Cyanosis improves. Urine becomes blue. We thank Karen and Parma Hospital for sharing this information with us. Colon Cancer Support Group Meets at The Gathering Place, which is located in The Arnold and Sydell Miller Family Campus at 23300 Commerce Park, Cleveland, Ohio 44122. For more information phone (216) 595-9546 or visit www.touchedbycancer.org. The group meets the first Thursday of each month from 7:00-8:30 PM. Please pass this information on to your patients, family or friends who may be affected by Colon Cancer. Scope Theft There have been many incidents of scope theft throughout area hospitals. You may want to evaluate how well your unit is securing your valuable equipment. Lock scope cabinets, lock units, limit access. Consult your security department for ideas of how to make your equipment more secure. Website Provided By: IMS - Integrated Medical Systems International, Inc. www.imsready.com

NCOSGNA Regional Society Officers

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