11/05/2025
The FDA recently warned about serious errors where tranexamic acid was mistakenly given intrathecally (into the spine) instead of intravenously, resulting in serious patient outcomes, including prolonged hospitalization and death. In a clinical environment with many distractions and high stakes, human error remains a persistent risk. Better than labeling and warnings, the strongest mitigation to this drug administration error would be to make the intravenous and neuraxial connectors incompatible. That’s the principle behind NRFit—a connector system designed specifically for neuraxial (spinal/epidural) use that is engineered to be mechanically incompatible with other medical connectors, including intravenous connectors. The use of dedicated NRFit connectors in intrathecal applications would heed the FDA’s warning while providing for the most effective reduction in the risks of inadvertent intrathecal administration of tranexamic acid.
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