Ondansetron Routes for 911/Palliative Patient's

Question#: 699

Question:

Directive for administration of Ondansetron for Palliative Care says first route of administration should be 4mg PO, then SC, IV, CVAD. We've only ever carried ampoules of Ondansetron (4mg/2mL) which say for IV. Was it ever messaged that this could be drawn up and given PO? I'm assuming because it's 2mLs that's why it doesn't suggest SC administration. Can you please verify if this medication (volume) can also be given SC?

Answer:

First and most importantly, we are currently in the process of making some changes at the provincial level so that there is no confusion between the two and they can be used interchangeably. For example, you could use the injectable form for a 911 call if your service carries it. Stay tuned for more on that! Presently, we will stick with current practice and use only the injectable form for palliative care. For now, it is not to be used for 911 patient’s.

Secondly, although the palliative directive does state PO as first priority, the physicians are okay with using clinical judgement and using the route that you think is most appropriate for that patient without necessarily going “in order” as per the medical directive. Although Ondansetron can be drawn up and giving orally, it is not recommended in a patient with nausea/vomiting as it tastes horrible and would likely exacerbate their symptoms. Therefore, if and when you are able to obtain Ondansetron dissolvable tablets/wafers, this would be recommended for palliative patients when administering it PO.

Lastly, depending on what you read the maximum volume of liquid that can be administered SC may vary (1.5-2ml) however, up to 4ml is acceptable. Therefore, the 4mg/2ml Ondansetron SC would be adequate.

As always, an OMC patch is encouraged if there are any questions the paramedics may have.