Drug Therapy Protocols: Box jellyfish antivenom
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Date
April, 2016
Purpose
Scope
Author
To ensure a consistent procedural approach to Box jellyfish antivenom administration.
Applies to all QAS clinical staff.
Clinical Quality & Patient Safety Unit, QAS
Review date
April, 2018
URL
https://ambulance.qld.gov.au/clinical.html
This work is licensed under the Creative Commons
Attribution-NonCommercial-NoDerivatives 4.0
International License. To view a copy of this license,
visit http://creativecommons.org/licenses/by-nc-nd/4.0/.
Box jellyfish antivenom
April, 2016
Drug class
Contraindications
Antivenom
UNCONTROLLED WHEN PRINTED
Pharmacology
Box jellyfish antivenom contains concentrated immunoglobulin that acts to neutralise the toxins present in the venom of the box jellyfish
(Chironex fleckeri ).[1-2] Metabolism
• KSAR or hypersensitivity to box jellyfish antivenom
Precautions
• The antivenom is a foreign protein, which can cause
sensitisation, allergic reaction or anaphylaxis
UNCONTROLLED WHEN PRINTED
Hepatic and in muscle tissue.[1]
Indications
Side effects
• Box jellyfish (Chironex fleckeri ) envenomation
associated with any of the following:
• Allergic reaction including anaphylaxis and delayed serum sickness
• Intense stinging sensation on injection
UNCONTROLLED WHEN PRINTED
- a patient currently in cardiac arrest
- decreased level of consciousness
- cardiac AND/OR respiratory distress or collapse
- total surface area affected greater than half the surface area of one limb
Presentation
• Ampoule, 20,000 units/1.5 – 4 mL box jellyfish antivenom
- intractable pain unrelieved by icepacks,
methoxyflurane AND/OR narcotic analgesia.
UNCONTROLLED WHEN PRINTED
Figure 4.6
Onset (IV)
Duration (IV)
Half-life
Not available
Not available
Not available
QUEENSLAND AMBULANCE SERVICE
735
Box jellyfish antivenom
October, 2015
Schedule
Special notes
• S4 (Restricted drugs).
UNCONTROLLED WHEN PRINTED
CCP
P
ACP2
Intramuscular injection (IM)
• The dose of antivenom is related to the dose of venom, not based on the size of the patient.[1] ACP1
Routes of administration
• Box jellyfish antivenom is to be available at all coastal QAS stations from Wide Bay LASN and north.
• At all times during antivenom therapy adrenaline (epinephrine) must be available in case of an anaphylactic reaction. If reaction
occurs, immediately cease the administration of box jellyfish
antivenom and treat patient in accordance with CPG: Anaphylaxis and allergy.
CCP
ACP2
UNCONTROLLED WHEN PRINTED
Intravenous injection (IV)
• IV injection is the preferred route of administration for all indications.
• If a patient is in cardiac arrest due to box jellyfish envenomation, the box jellyfish antivenom is only to be administered following the commencement of effective CPR, advanced life support measures and administration of cardioactive drugs.
UNCONTROLLED WHEN PRINTED
• Box jellyfish antivenom is not currently supplied by the QAS – for procurement information please refer to the QAS Drug Management Code of Practice.
UNCONTROLLED WHEN PRINTED
• Box jellyfish antivenom must be protected from light and stored
between 2–8°C. DO NOT FREEZE.
QUEENSLAND AMBULANCE SERVICE
736
Box jellyfish antivenom
October, 2015
Adult dosages (cont.)
Adult dosages
UNCONTROLLED WHEN PRINTED
• Cardiac AND/OR respiratory distress or collapse
• Total surface area affected greater than half the surface area of one limb
associated with a patient currently in cardiac arrest
CCP
• Decreased level of consciousness
Box jellyfish (Chironex fleckeri) envenomation
ACP2
Box jellyfish (ChIronex fleckeri) envenomation
associated with any of the following:
IV
20,000 units
Slow push over 2–5 minutes.
Repeated immediately up to 2 times. Total maximum dose 60,000 units.
UNCONTROLLED WHEN PRINTED
CCP
ACP2
P
ACP1
• Intractable pain unrelieved by icepacks, methoxyflurane AND/OR narcotic analgesia
IM
Syringe preparation: Mix 20,000 units of antivenom with sodium chloride 0.9% to achieve a final concentration of 20,000 units/20 mL.
60,000 units
Single dose only.
CCP
ACP2
UNCONTROLLED WHEN PRINTED
IV
INF
20,000 units
Infusion over 20 minutes.
Administer via SPRINGFUSOR® 30 mL Single dose only.
Syringe preparation: Mix 20,000 units of antivenom with sodium chloride 0.9%
in a 30 mL SPRINGFUSOR® syringe to
achieve a final concentration of 20,000 units/20 mL. Administer via
SPRINGFUSOR® at a rate of 60 mL/hour
(over 20 minutes).
UNCONTROLLED WHEN PRINTED
QUEENSLAND AMBULANCE SERVICE
737
Box jellyfish antivenom
October, 2015
Paediatric dosages
Paediatric dosages (cont.)
UNCONTROLLED WHEN PRINTED
• Cardiac AND/OR respiratory distress or collapse
• Total surface area affected greater than half the surface area of one limb
associated with a patient currently in cardiac arrest:
CCP
• Decreased level of consciousness
Box jellyfish (Chironex fleckeri) envenomation
ACP2
Box jellyfish (Chironex fleckeri) envenomation
associated with any of the following:
IV
20,000 units Slow push over 2–5 minutes.
Repeated immediately up to 2 times. Total maximum dose 60,000 units.
UNCONTROLLED WHEN PRINTED
CCP
ACP2
P
ACP1
• Intractable pain unrelieved by icepacks, methoxyflurane AND/OR narcotic analgesia
IM
Syringe preparation: Mix 20,000 units of antivenom with sodium chloride 0.9%
to achieve a final concentration of 20,000 units/20 mL.
60,000 units
Single dose only.
CCP
ACP2
UNCONTROLLED WHEN PRINTED
IV
INF
20,000 units
Infusion over 20 minutes.
Administer via SPRINGFUSOR® 30 mL
Single dose only.
Syringe preparation: Mix 20,000 units of antivenom with sodium chloride 0.9%
in a 30 mL SPRINGFUSOR® syringe to
achieve a final concentration of 20,000 units/20 mL. Administer via
SPRINGFUSOR® at a rate of 60 mL/hour
(over 20 minutes).
UNCONTROLLED WHEN PRINTED
QUEENSLAND AMBULANCE SERVICE
738