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Drugs in R&D Mar 2021Intravenous drug administration is associated with potential complications, such as phlebitis. The physiochemical characteristics of the infusate play a very important...
BACKGROUND
Intravenous drug administration is associated with potential complications, such as phlebitis. The physiochemical characteristics of the infusate play a very important role in some of these problems.
AIM
The aim of this study was to standardize the dilutions of intravenous drugs most commonly used in hospitalized adult patients and to characterize their pH, osmolarity and cytotoxic nature to better guide the selection of the most appropriate vascular access.
METHODS
The project was conducted in three phases: (i) standardization of intravenous therapy, which was conducted using a modified double-round Delphi method; (ii) characterization of the dilutions agreed on in the previous phase by means of determining the osmolarity and pH of each of the agreed concentrations, and recording the vesicant nature based on the information in literature; and (iii) algorithm proposal for selecting the most appropriate vascular access, taking into account the information gathered in the previous phases.
RESULTS
In total, 112 drugs were standardized and 307 different admixtures were assessed for pH, osmolarity and vesicant nature. Of these, 123 admixtures (40%), had osmolarity values >600 mOsm/L, pH < 4 or > 9, or were classified as vesicants. In these cases, selection of the most suitable route of infusion and vascular access device is crucial to minimize the risk of phlebitis-type complications.
CONCLUSIONS
Increasing safety of intravenous therapy should be a priority in the healthcare settings. Knowing the characteristics of drugs to assess the risk involved in their administration related to their physicochemical nature may be useful to guide decision making regarding the most appropriate vascular access and devices.
Topics: Adult; Algorithms; Delphi Technique; Humans; Hydrogen-Ion Concentration; Infusions, Intravenous; Inpatients; Irritants; Osmolar Concentration; Phlebitis; Spain; Vascular Access Devices
PubMed: 33346878
DOI: 10.1007/s40268-020-00329-w -
The American Journal of Medicine Mar 2020
Topics: Adult; Cannula; Humans; Phlebitis; Splints
PubMed: 31442390
DOI: 10.1016/j.amjmed.2019.07.047 -
Phlebology Oct 2022
Topics: Humans; Thrombophlebitis; Veins
PubMed: 35980278
DOI: 10.1177/02683555221122640 -
Rheumatology (Oxford, England) Dec 2020
Topics: Adult; Humans; Male; Phlebitis; Takayasu Arteritis
PubMed: 32617559
DOI: 10.1093/rheumatology/keaa333 -
Cleveland Clinic Journal of Medicine Apr 2020
Topics: Aged; Humans; Leg; Male; Thrombophlebitis
PubMed: 32238373
DOI: 10.3949/ccjm.87a.19086 -
Deutsches Arzteblatt International Feb 2020
Topics: Aged, 80 and over; Humans; Male; Thrombophlebitis
PubMed: 32181733
DOI: 10.3238/arztebl.2020.0125 -
Neurocritical Care Apr 2023Hyperosmolar therapy is the cornerstone of medical management of sustained elevated intracranial pressure from cerebral edema. Acute intracranial hypertension and...
BACKGROUND
Hyperosmolar therapy is the cornerstone of medical management of sustained elevated intracranial pressure from cerebral edema. Acute intracranial hypertension and herniation is a medical emergency that requires rapid treatment and stabilization to prevent secondary brain injury or death. Intravenous hypertonic sodium chloride (NaCl) 23.4% is an effective treatment modality commonly used in this setting. Because of its high osmolarity, use has historically been limited primarily to central venous line administration as an intermittent infusion due to concerns about thrombophlebitis, injection site pain, and tissue necrosis or injury with extravasation. The objective of this analysis was to prospectively evaluate the safety of administration of 23.4% NaCl as a rapid intravenous push over 2-5 min.
METHODS
A prospective analysis of patients admitted between April 2021 and December 2021 who received 23.4% NaCl intravenous push over 2-5 min in a central or peripheral line was performed. Safety end points included incidence of new onset hypotension [defined as systolic blood pressure (SBP) < 90 mm Hg or SBP decrease of at least 20 mm Hg], bradycardia (defined as heart rate < 50 beats per minute), and infusion site reactions documented within 1 h of administration. For secondary safety outcomes, highest and lowest SBP and lowest heart rates documented within 1 h before 23.4% NaCl administration were compared with values collected within 1 h post administration and evaluated by mixed-design analysis of variance test with adjustment for peripheral versus central line administration.
RESULTS
We identified 32 patients who received 79 administrations of 23.4% NaCl through a central line or peripheral line during the study period. An SBP decrease of at least 20 mm Hg was observed in 13% of patients, an SBP < 90 mm Hg occurred in 16% of patients, and bradycardia occurred in 3% of patients who received 23.4% NaCl. Injection site pain was reported by one patient without documented thrombophlebitis, cellulitis, or tissue damage. Pain was not reported during two subsequent administrations in the same patient. There was no documented occurrence of soft tissue injury or necrosis in any patient. Compared with baseline vital signs before 23.4% NaCl administration, no difference in vital signs post administration was observed.
CONCLUSIONS
Central and peripheral administration of 23.4% NaCl over 2-5 min was well tolerated, and incidence of hypotension, bradycardia, or infusion site-related adverse events was rare.
Topics: Humans; Sodium Chloride; Bradycardia; Intracranial Pressure; Saline Solution, Hypertonic; Intracranial Hypertension; Hypotension; Thrombophlebitis
PubMed: 36171519
DOI: 10.1007/s12028-022-01604-1 -
Journal of Vascular Surgery. Venous and... Jul 2020
Topics: Cyanoacrylates; Humans; Phlebitis; Saphenous Vein
PubMed: 32553656
DOI: 10.1016/j.jvsv.2020.02.009 -
Mayo Clinic Proceedings Dec 2023
Topics: Humans; Cannabis; Arteritis; Phlebitis; Thrombophlebitis
PubMed: 38043999
DOI: 10.1016/j.mayocp.2023.06.013 -
Current Pediatric Reviews 2023Severe thrombosis in the neonate presents a diagnostic challenge to the clinician as the benefits and risks for treatment must be weighed with every medical decision.... (Review)
Review
Severe thrombosis in the neonate presents a diagnostic challenge to the clinician as the benefits and risks for treatment must be weighed with every medical decision. Aortic thromboses, large right atrial thromboses, and septic thrombophlebitis present unique clinical challenges that must be managed in the appropriate clinical setting with appropriate subspecialty support. Unfortunately, there is limited data on what the ideal therapy should be for these specific types of cases. In this review, we will discuss these types of severe thromboses that may occur in neonates and potential therapies that may offer benefits.
Topics: Infant, Newborn; Humans; Thrombophlebitis
PubMed: 36424785
DOI: 10.2174/1573396319666221124121815