目的:描述间歇性碳青霉烯输注的护士准备和给药。
方法:这项观察性研究记录了在三个普通重症监护病房中对成年患者的碳青霉烯输注过程。
方法:观察输注时间和持续时间。进行输注项目的体积分析以确定在制备和施用阶段重建的碳青霉烯的损失。
结果:观察到对20名成年患者进行碳青霉烯输注(n=223)。输注持续时间指导是可变的,有两个ICU遵循当前的文献建议,和一个ICU参考药物包装插入信息。在这些参数中,只有60%的输液符合输液持续时间.不遵守计划的给药时间会影响所需的给药间隔。在以下过程中发现了预期剂量的不完全输送:小瓶的次优重建,重建的小瓶数量不正确,未能施用剂量(错过剂量),丢弃输液物品中的抗生素残留物。输注项目的体积分析显示在丢弃的小瓶和注射器中平均剂量损失4.9%和1.2%。在废弃的输液袋和输液管路上分别发生6.3%和30.8%的平均药物损失。没有观察到冲洗指导或实践。
结论:不正确的护士使用抗生素会导致不同的输注持续时间和未给药处方剂量。给药不足有可能导致细菌抗生素抗性的选择压力。通过输注静脉内递送抗微生物剂的频率增加需要了解所需的施用持续时间以及一旦输注完成如何管理静脉内管线中剩余的残留药物。
结论:间歇性抗菌输注后冲洗给药线并不常见。尽管重症监护领域存在抗菌药物耐药性的多因素风险因素,护士输液实践必须确保患者接受预期的抗菌治疗.必须注意在处置含有未递送的抗微生物药物的输液物品时,由于环境污染而产生抗微生物剂耐药性的可能性。
OBJECTIVE: To describe nurse preparation and administration of intermittent carbapenem infusions.
METHODS: This observational study documented the carbapenem infusion process to adult patients in three general intensive care units.
METHODS: Timing and duration of infusions were observed. Volumetric analysis of infusion items was conducted to determine loss of reconstituted carbapenem during preparation and administration phases.
RESULTS: Carbapenem infusions (n = 223) administered to twenty adult patients were observed. Infusion duration guidance was variable, with two ICUs following current literature recommendations, and one ICU referring to medication package insert information. Within these parameters, only 60 % of infusions complied with infusion duration. Non-compliance with planned time of administration impacted on desired dosing intervals. Incomplete delivery of intended dose was found during: sub-optimal reconstitution of vials, incorrect number of vials reconstituted, failure to administer a dose (missed dose), and discarding antibiotic residue in infusion items. Volumetric analysis of infusion items showed mean dose losses of 4.9 % and 1.2 % in discarded vials and syringes. Mean drug losses of 6.3 % and 30.8 % occurred in discarded infusion bags and infusion lines respectively. No flushing guidance or practice was observed.
CONCLUSIONS: Incorrect nurse administration of antibiotics resulted in varying durations of infusions and the non-delivery of prescribed dose. Under-dosing has the potential to contribute to selection pressure for bacterial antibiotic resistance. The increasing frequency of intravenous delivery of antimicrobial agents through infusions requires an understanding of the required duration of administration and how to manage residual drug remaining in the intravenous line once the infusion is completed.
CONCLUSIONS: Flushing of administration lines is not common practice following intermittent antimicrobial infusions. Although there are multi-factorial risk factors for antimicrobial resistance in the critical care arena, nurse infusion practice must ensure that patients receive intended antimicrobial treatment. Attention must be given to the potential for antimicrobial resistance from environmental contamination with the disposal of infusion items containing undelivered antimicrobial medication.