Letby Case (part 2)

[OneFrenchEgg]

www.mumsnet.com/talk/_chat/4652340-lucy-letby-court-case?reply=121815754

follow up, remember rules around discussion of active cases

Started this as the other one was nearly at close

Thank you

Thanks

Pmk

Ta!

As a pharmacist who has previously worked on an NNU, our hospital did have stock bags kept in case TPN was needed outside usual opening times.
They were ordered from a supplier, received into stock in pharmacy and kept in a fridge there. As the NNU used stock bags they were replaced, unless specifically told they were running low they would get these weekly. They kept maybe 4 starter bags and 4 maintenance bags. Generally the starter bags used were the stock bags, then bespoke for the baby was ordered after that.
Maintenance bags were only really used over bank holiday weekends due to aseptic unit being closed, or if there was a problem with the bag.
The bags were easily accessible in the NNU fridge by anyone. The fridge also was hardly ever locked, and often the locks on the hospital fridges are so poor they can be opened with the corner of someone's ID badge so there wouldn't even be a trail of who had the keys at any point.
Insulin vials would be kept in the same fridge, so would be relatively easy to inject a bag with insulin. You wouldn't know which baby would get the bag though.

Thanks for the thread.

Thanks for the new thread

Thank you @Pharmacistquestion . Is there any time insulin would be added to
Those bags? Is there any way, through incompetence, or accident, insulin could. Have got into them? Or only trough deliberate tampering?

Thank you, so when the child has to have insulin, it would have been a simple injection?

Insulin vials would be kept in the same fridge, so would be relatively easy to inject a bag with insulin. You wouldn't know which baby would get the bag though.

Interesting. If it was injected wouldn’t the bag leak slowly?

A post on the last thread said that there are usually ports so that medications can be added. I’m not a HCP though so that could probably use backing up.

(Thanks for the new thread @OneFrenchEgg )

@Mirabai there's a port for injections on fluid bags

No insulin would never be added to a fluid bag. It should always be given via a separate infusion that can be adjusted according to the patients blood sugar levels. A sliding scale of insulin is always used rather than a fixed dose.

Neonatess never have insulin injections, it's always mixed with saline and given as a continuous infusion.

Thanks for new thread. Following!

Just checking in for later so I don't lose the new thread.

Yes it was established on the previous thread these bags have ports. But a port allowing insulin to infuse is not the same as an “injection” - which is the word that poster used. Unless that’s not what she meant.

You asked why the TPN bag wouldn't leak after being [maliciously] injected with insulin and @clockapp correctly told you that there are ports for [legitimate] injections

The ports have self-sealing rubbery caps - when the needle is withdrawn the tiny hole closes

No leaks

Insulin infusions are a completely separate issue and never involve bags of TPN

Pharmacistquestion. Do you have any thoughts about how quickly the efects of a large dose of IV insulin would wear off once the infusion stopped? I'm thinking fairly quickly, in that changing the rate of 'normal' infusions has quite a rapid effect. This is crucial isn't it, as if the bag was changed to an uncontaminated bag around midday, as it should have been, the blood glucose should have started to rise not too long after.

So to get this straight - there are ports for “injections” so insulin could be injected into a TPN bag without detection. But that is not the way that insulin infusions are normally performed - is that correct?

Yes that's right

Insulin infusions [insulin plus approx 50mls of saline soln] are given by a separate iv line and use a 'pump' so that small carefully measured amounts of infusion can be slowly delivered in a controlled fashion.

.

That’s really helpful.