Does carrier fluid reduce low flow drug infusion error from syringe size?  

作　　者：Zachary C Madson Sitaram Vangala Grace T Sund James A Lin 

机构地区：[1]Pediatric Hospitalist Medicine,Lutheran Children's Hospital,Fort Wayne,IN 46804,United States [2]Medicine Statistics Core,David Geffen School of Medicine at UCLA,Los Angeles,CA 90095,United States [3]Department of Nursing,UCLA Mattel Children's Hospital,Los Angeles,CA 90095,United States [4]Department of Pediatrics,David Geffen School of Medicine at UCLA,Los Angeles,CA 90095,United States

出　　处：《World Journal of Clinical Pediatrics》2020年第2期17-28,共12页世界临床儿科杂志

基　　金：Supported by NIH National Center for Advancing Translational Sciences(NCATS)UCLA CTSI,No.UL1TR001881.

摘　　要：BACKGROUND Critically ill neonates and pediatric patients commonly require multiple low flow infusions.Volume limitations are imposed by small body habitus and comorbidities like cardiopulmonary disease,renal failure,or fluid overload.Vascular access is limited by diminutive veins.Maintenance fluids or parenteral nutrition in conjunction with actively titrated infusions such as insulin,fentanyl,prostaglandins,inotropes and vasopressors may necessitate simultaneous infusions using a single lumen to maintain vascular catheter patency.This requirement for multiple titratable infusions requires concentrated medications at low flows,rather than more dilute drugs at higher flows that in combination may volume overload small infants.AIM To determine whether carrier fluid reduces variability that variability of low flow drug infusions is proportional to syringe size in pediatric critical care.METHODS We assessed concentrations of orange“drug”in a 0.2 mL/h low flow clinical model with blue dyed carrier fluid at 5 mL/h,using 3-,10-,or 60-mL syringes.A graduated volumetric pipette was used to measure total flow.Mean time to target concentration was 30,21,and 46 min in 3-,10-,and 60-mL syringes,respectively(P=0.42).After achieving target concentration,more dilute drug was delivered by 60-mL(P<0.001)and 10-mL syringes(P=0.04)compared to 3-mL syringes.Drug overdoses were observed during the initial 45 min of infusion in 10-and 60-mL syringes.Total volumes infused after target concentration were less in the 60-mL condition compared to 3-mL(P<0.01)and 10-mL(P<0.001)syringes.RESULTS Linear mixed effects models demonstrated lesser delivered drug concentrations in the initial 30 min by 3-mL compared to 10-and 60-mL syringes(P=0.005 and P<0.001,respectively)but greater drug concentrations and total infused drug in the subsequent 30-60 and 60-90 min intervals with the 3-and 10-mL compared to 60-mL syringes.CONCLUSION With carrier fluid,larger syringes were associated with significantly less drug delivery,less total volume deliver

关 键 词：Infusion pumps Intensive care NEONATAL Nursing research Patient safety SPECTROPHOTOMETRY SYRINGES 

分 类 号：R473.72[医药卫生—护理学]