Using the Wrong Exactacain Straws can Endanger Patients

Posted on April 29, 2008

In a recent article, the Institute for Safe Medication Practices warned that using the wrong disposable straw with Exactacain can pose a safety risk to patients. Exactacain (benzocaine 14%, butamben 2%, tetracaine 2%). Exactacain is a local anesthetic spray which is used to numb patients' throats before endoscopy. It is delivered through a disposable straw that is inserted into a spray release button on top of the can.

The problem is that the manufacturer changed the spray release button last year, and that necessitated changing the diameter of the disposable straws that come packaged with the product. If the old red straws are used with the new spray cans, or the new clear straws with the old spray cans, a tight fit may not be achieved, and the straw could pop off into the patient's throat. This is especially dangerous, since the anesthetic dulls the gag reflex.

When using Exactacain, be sure to use only the straws that come with the bottle. Discard any leftover straws when starting a new bottle. And be sure to press the straw firmly into the hole in the spray applicator to get a tight fit.

The ISMP article reminds practitioners that using too much of a topical anesthetic spray can cause methemoglobinemia, which can lead to cyanosis and coma. ISMP says that the usual dose of Exactacain is three sprays, and that more than six should never be administered.

Additional Information:

ISMP Medication Safety Alert! Warning! Exactacain Straw Must Fit Release Button. July 12, 2007.
http://www.ismp.org/Newsletters/acutecare/articles/20070712_1.asp