UK - Nurse Lucy Letby Faces 22 Charges - 7 Murder/15 Attempted Murder of Babies #7

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Kemug

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My body is trying to fall asleep down here in Oz, so I haven't got the strength or concentration to go back and look for the details - but I am wondering if there were any babies who were deliberately harmed earlier (after LL began to work there.) Yes, there were far fewer deaths in previous years, but that doesn't prove that LL (allegedly) didn't harm any of those babies. And others. I wonder if LE is checking those other babies out. Rather than suddenly becoming a prolific killer after a number of years at the hospital, it would make more sense if LL (allegedly) started small, and then attacked more babies as her confidence grew.
 

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2:11pm

An Alaris syringe driver video is displayed to the court, showing how a syringe dose can be electronically administered via infusion, at various rates. These rates can be locked.
It is similar to the Alaris pump, and has alarms if the syringe is not loaded properly, if the infusion has been placed 'on hold' for a certain length of time, if the rate has been changed but has not been confirmed, if the infusion is complete, if there is a power failure or low on battery, if there is an error message.
The alarm colour would be amber on the machine, and can be paused for two minutes.
An event log would be available on the machine for 24 hours.
The nurse confirms it was a standard machine used at the Countess of Chester Hospital, and was standard practice.
The nurse said the event log wouldn't be looked at routinely by staff.

LIVE: Lucy Letby trial, Thursday, November 24
 

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2:16pm

An 'occlusion' alarm would be a red alarm light, with an alarm sound.
The syringe would be primed beforehand with the fluid, attaching the syringe to a line, and would be 'flushed' so no air would be present.
The nurse says a different piece of equipment would be used for TPN bags, and this equipment would be used for the lipid [fats] element administered via syringe.
The nurse says this equipment would be used to administer smaller amounts of fluids, such as 10% dextrose, or a saline bolus, or antibiotics.

LIVE: Lucy Letby trial, Thursday, November 24
 

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2:20pm

The video demonstrates an 'accelerated rate' of a drug could be administered via infusion via a 'purge' function on the machine, which would be used as a possible bolus administration.
The nurse says that 'purge' button would not be used at the Countess of Chester Hospital, and was not standard practice.

LIVE: Lucy Letby trial, Thursday, November 24
 

Tortoise

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2:22pm

The video adds the 'purge' function would not add to the total millilitres of infusion administered on the machine's display - ie, any fluids administered during that 'purge' time would not be added to the total the machine had calculated so far.
The machine also does not have the ability to detect air, the video presented to the court concludes.

LIVE: Lucy Letby trial, Thursday, November 24
 

JosieJo

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2:31pm

An IV administration chart for August 5 is shown to the court, with four 10% dextrose infusions focused on.
The nurse has co-signed for two of the four administrations, both boluses at 8.30am and 3.15pm. One more would have been through a bolus and another via an infusion at a certain rate, which would require mechanical assistance.
The nurse said she would have delivered the two boluses she signed for as a 'push' infusion (ie, push the fluid manually via syringe attached to a clean, 'flushed' infusion line), and the process would be 'straightforward'.

2:40pm

The nurse is shown a note from the 'grand round', which the court heard was carried out by the on-call consultant each Wednesday.
The note 'new long line' was made, and the nurse says that was because the existing long line had tissued.
The new long line was made at noon on August 5.

 
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covid2020

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"Interestingly, at the end of this part of the interview she asked whether the police had access to the TPN bag that she had connected," Mr Johnson added."

Actually this sounds like an admission too, if she said it like that.

<modsnip> If I was being accused of contaminating a TPN bag I would also want to know if the police had the bag to prove their claim.
 
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JosieJo

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2:44pm

The nurse says her normal practice would have been for putting a new bag of fluids on the long line.

2:45pm

The Alaris pump video is shown once again to the court, for the nurse to provide potential further context on what is demonstrated in the video.

 

JosieJo

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2:48pm

The Alaris pump would be used in connection with TPN bags.
The nurse says while there is an input port on the TPN bag, she would not input anything manually in conjunction with the machine.
The output port would be used for 'giving' the infusion to the patient.
 

JosieJo

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2:54pm

The nurse confirms a 10% dextrose administration was given to Child F at 3.30pm via an infusion.
She tells the court the 10% dextrose infusion would have been administered, in addition to the existing dose from the new bag at noon, as the blood glucose level was still low for Child F.
The nurse says the 3.30pm dose would have been administered via a syringe.
Lipids would have been administered via a syringe driver.

 

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3:01pm

The court is shown a 15% dextrose dose, plus sodium chloride, is administered for 7pm on August 5. The nurse has signed for that medication administration.
The nurse is also a co-signer for medication at 2am on Thursday, August 6.
The nurse explains the practice was someone from the day shift (in this case, herself) would co-sign for the drug during the day, then she would in practice text the person who was administering it to confirm it had been administered, and that the scheduled dose could be taken 'off the system' and wasn't at risk of being administered twice.

3:07pm

Ben Myers KC, for Letby's defence, asks about the administration of the drugs, and how they are administered.
The nurse says the 10% dextrose would come in 500ml bags, and can be divided up on the unit for infusions, or come available via the pharmacy in 50ml pre-made doses.
The nurse says she does not have an independent recollection of the event.
She confirms if the long line is tissued, it cannot be used again.
Mr Myers says if the long line is changed, then everything else is changed to avoid infection, including the TPN bag. The nurse confirms that would be the case.
Mr Myers: "You wouldn't put up an old [TPN] bag, would you?"
The nurse: "I wouldn't, no. And we wouldn't have put it up as we would have documented that."

3:08pm

Mr Myers says as a general rule, TPN bags would run for 48 hours unless there was a problem, and there would be a stock of maintenance bags in the fridge.
Mr Myers says one of those would have been used in the course of this. The nurse agrees.
The nurse says such bags are checked every night and if any were being used or out of date, then the stock would be replenished.

3:10pm

Simon Driver, for the prosecution, asks about the stock bags in the refrigerator.
He says every night, a check would be undertaken to see if any had been used.
He asks how the checker would know if they had been used.
The nurse says if there weren't the stock five TPN bags in the fridge, new ones would be ordered.
The refrigerator would have 'start-up' TPN bags and 'maintenance' TPN bags of nutrition.
The nurse says there may be fewer 'target stock' of the 'start-up' TPN bags.

3:11pm

Each of the bags would have a dated 'shelf life' the court hears.
The nurse says the bags would not be ordered in any particular fashion in the fridge.

3:15pm

A video of glucose/dextrose administration is played to the court.
The procedure is described as a 'two-person procedure'.

LIVE: Lucy Letby trial, Thursday, November 24
 

Tortoise

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3:23pm

A question from a juror asks if the syringe driver could administer an infusion if the line has not been primed (ie if the line still has air in it).
The nurse confirms that would be the case. The equipment could have a filter connected, but it was the practice that the line would be primed before use.

LIVE: Lucy Letby trial, Thursday, November 24
 

Ruby12345

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3:23pm

A question from a juror asks if the syringe driver could administer an infusion if the line has not been primed (ie if the line still has air in it).
The nurse confirms that would be the case. The equipment could have a filter connected, but it was the practice that the line would be primed before use.

LIVE: Lucy Letby trial, Thursday, November 24
Sorry if I'm being stupid but what is the juror getting at with that question?
 
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