Nhau

Mubvunzo: Norepinephrine ndiyo yakakwirira-kuwanikwa zvinodhaka iyo inotumirwa intravenously (iv) sekuenderera mberi kwekunyepedzera. Iyo Vasopressor iyo inowanzo kuve yechokwadi kuchengetedza kweropa rakaringana uye chinangwa chemufuro mukurwara nevakuru vanotadza uye vana vane hypotsion zvakanyanya kana kuvhunduka kunoramba kuchikwira kunyangwe kuwanda kwemvura. Kunyangwe zvidiki zvikanganiso mukuita chegumi kana dosi, pamwe nekunonoka kurapwa, zvinogona kutungamira kune njodzi dzemigove. Iyo Elseceseute Hutano hwehutano nguva pfupi yadarika Tumira ISP iyo yakanakira kuongororwa kwakajairika Dhata kubva muchirongwa chesangano yekushuma uye smart influsion pumps yakashandiswa kuona zvinogona kukanganisa zvikanganiso.
ISMP yakagamuchirwa 16 Noradrenaline-yakabatana mishumo muna 2020 uye 2021 kuburikidza neIDMP yenyika yekukanganisa kukanganisa kwekutaurisa chirongwa (ISMP Merp). Chetatu cheiyi mishumo inobata nengozi dzinosanganiswa nemazita akafanana, mavara, kana kurongedza, asi hapana zvikanganiso zvakanyatso kutaurwa. Isu takaburitsa mishumo yemurwere manomwe emurwere ekukanganisa okukanganisa: Chikanganiso china Chikanganiso (Kubvumbi 16, 2020; Nyamavhuvhu 26, 2021; Kukadzi 24, 2022); Chikanganiso chimwe chekusavimbika chisina kunaka; Chikanganiso chimwe chegumi chisina kujeka chemushonga; kukanganisa kwengozi kweNorepinephrine Infusion. All 16 Hevp mishumo yakawedzerwa kune cca Multenter Health System (n = 106) uye iyo yakagadziriswa mhedzisiro (n = 122) yenhanho imwe neimwe mukushandisa zvinodhaka zvinoratidzwa pazasi. Iko kukanganisa kwakasanganiswa kunosanganisirwa kupa muenzaniso wezvimwe zvinokonzeresa.
Nyora. Isu takaratidza zvinhu zvinoverengeka zvine chekuita nekuraira zvikanganiso, zvinosanganisira kushandisa zvisina kufanira kwemirairo yemuromo, uye zvisina kujairika kana kusaziva kana kusaziva. Dzimwe nguva iyo yakagadziriswa titration parameter yakanyanya kujairika kana kuti isingabatsiri (semuenzaniso, kukwirisa kwakatarwa kwakakura kwazvo), zvichiita kuti zviome kune vanamukoti kuti vatevedzere kuongorora kweropa reropa. Mune zvimwe zviitiko, vanachiremba vanogona kunyora kurema-kwakavakirwa kana kusiri-kuremerwa madhiri, asi izvi dzimwe nguva zvinovhiringidzika. Izvi-zve-bhokisi zvinonyora zvinowedzera mukana wevarapi vepopend vepopengen kuita zvikanganiso, kusanganisira pombi propit kuratidzwa, sezvo maviri ekugadzirisa sarudzo anowanikwa mune raibhurari yepombi. Mukuwedzera, kunonoka kwaishuma kunoda kujekeswa kujekesa kana kuraira mirairo yaisanganisira uremu-hwakavakirwa uye risiri-uremu-hwakavakirwa mirayiridzo.
Chiremba anobvunza mukoti kunyora mishonga yeNorepinephrine yemurwere nekumanikidzwa kweropa risingaperi. Mukoti akapinda muhurongwa chaizvo sezvakarairwa nemuromo, Asi iyo dosi's Dosage mirayiridzo isina-uremu-yakavakirwa pasi nehuremu-hwakavakirwa projekiti: Medication Iyo Sangano Smart Finussion Pombi haina kukwanisa kutarisa iyo McG / min DoE kune Yakakura Uremu-based Dese, MCG / KG / min. Vatariri veMapermacists vaifanira kutarisa mirayiridzo nevanachiremba, iyo yakatungamira kunonoka mukupa hanya.
Gadzirira uye ugovape. Kugadzirira kwakawanda uye kurasa zvikanganiso zvinokonzerwa nekunyanyisa mutambi webasa tungamira kultitasking uye kupera simba. Zvimwe zvinokonzeresa zvinokonzeresa zvikanganiso zvinosanganisira Label Labels zvakavanzika mumabhegi echiedza uye kushaya nzwisiso nemapepa ekurumidzira kwekukurumidzira kwekuparadza.
A-incupation yeNorepinephrine uye Nicardipine mune yakasviba amber bhegi yakatadza. Kuti uwane rima rima, iyo inomira system yakadhindwa mavara maviri, imwe pane iyo infusion bag pachayo uye imwe kunze kweiyo amber bhegi. Norepinephrine infusions yakaiswa muAmber mapaketi akanyorwa "nicardipine" isati yagoverwa chigadzirwa kuti ishandiswe nevarwere vakasiyana uye vice verssa. Zvikanganiso hazvina kucherechedzwa usati wabvisa kana kurovera. Murwere akarapwa neNikariri yakapihwa nokwati asi haina kukonzeresa kwenguva refu.
Administrative. Zvikanganiso zvakajairika zvinosanganisira zvisirizvo kutaura kana kukanganisa kwekukanganisa, kukanganisa kwerudzi zvisiri izvo, uye kukanganisa kwezvinodhaka. Zvizhinji zvezvikanganiso izvi zvinokonzerwa nehurongwa husina kunaka hwekuita smart pombi, muchikamu nekuda kwekuvapo kwekusarudzwa kwekusarudzwa muraibhurari, uremu uye uripo; zvikanganiso zvekuchengetedza; Kubatana uye kuyanana kwekukanganisa kana kumiswa kufungidzirwa kune murwere kwakatanga kufuka zvisiri izvo kana kuti haana kuvatevedza kana kutangazve kana kutangazve kunhuwa. Pane chimwe chinhu chakakanganisika mumakamuri emergency uye makamuri ekushandisa, uye smart pump kuenderana neyemagetsi hutano marekodhi (ehr) aisawanikwa. Kuwedzeredza kunotungamira kune tishu kukuvara kwakataurwa zvakare.
Mukoti akatumira norepinephrine sekurairwa pachiyero che 0.1 μg / kg / min. Panzvimbo pekuronga pombi yekununura 0.1 mcg / kg / min, mukoti akaronga pombi kuti aendese 0.1 mcg / min. Nekuda kweizvozvo, murwere akawana ka80 times assplay norepinephrine pane yakatarwa. Kana inconussion ichisvika zvishoma nezvishoma uye yasvika pamwero we1.5 Nekuti murwere anoreva kuratidzwa kumanikidzwa kwaive kuchiri kusarongeka, yechipiri Vasopressor akawedzerwa.
Inventory uye yekuchengetedza. Zvizhinji zvikanganiso zvinoitika kana kuzadza otomatiki dispeatcal makabati (adcs) kana kuchinja norepinephrine vials mumakadhi emakadhi. Chikonzero chikuru chekukanganisa aya maitiro akafanana nekunyora uye kurongedza. Nekudaro, zvimwe zvikonzero zvakajairika zvakazoonekwawo, zvakadai seyakaderera zviyero zveNorepinephrine infssions kuAdc isina kugadzikana kwekuriritira Kukundikana kuongorora barcode yeechero yega yega yew norepinephrine chigadzirwa paunenge uchichengetedza adc imwe yakajairika yekukanganisa.
Iyo pharmacist isingakanganiswe iyo adc ine pharmacy-yakagadzirirwa 32 mg / 250 ml Norepinephrine Solution muMoufacturer's 4 mg / 250 ml Premix Draimik. Mukoti akasangana nechikanganiso achiedza kugamuchira 4 mg / 250 ml norepinephrine infusion kubva ku adc. Iyo barcode pane yega yega infination haina kuongororwa usati waiswa muADC. Kana mukoti paakaziva kuti kwaingova ne33 mg / 250 ml bhegi muADC (inofanira kunge iri mufrigirmu chikamu cheADC), akakumbira kukwana kwakaringana. Norepinephrine 4Mg / 250ml influsion isiripo mumishonga inoenderana nekusaita mari yekugadzira
Tarisa. Kuongorora zvisirizvo kwevarwere, titration yeNorepinephrine Infanhupu kunze kwekurongedza paramita, uye kwete kutarisira apo iyo inotevera influsion bhegi iri kudikanwa ndiyo inowanzoitika zvikonzero zvekutarisa.
Murwere anofa nemirairo kuti "usashandise" jekiseni ine norepinephrine yekugara kwenguva yakareba kuti mhuri yake itaure zvakanaka. Iyo norepinephrine influsion yakapera, uye pakanga pasina bhegi rekusara mune adc. Mukoti akabva angodaidza iyo pharmacy uye akabvunza bhegi idzva. Iyo pharmacy haina nguva yekugadzirira mushonga mushonga usati waenda uye ukataura zvakanaka kumhuri yake.
Njodzi. Yese njodzi iyo yaisazoguma nekukanganisa inotaurwa kune ISmp uye inosanganisira zvakafanana mazita ekunyora kana emishonga. Mishumo yakawanda inoratidza kuti kurongedza uye nekunyora kwezvikamu zvakasiyana-siyana zveNorepinephrine infusions inoparadzaniswa neyekunze makumi mashanu
Kurudziro yeitiro yakachengeteka maitiro. Funga nezve dziratidzo dzinotevera kana dzichikudziridza kana kudzokorora zano rako rekuita zvikanganiso mukushandisa kwakachengeteka kweNorepinephrine (uye zvimwe Vasopress) incussions:
Limit kuora. Yakagadziriswa yehuwandu hushoma hwekutarisisa kwekurapa kwePediatric uye / kana varwere vakuru. Taura uremu muganho wekunyanyisa kufungidzirwa kwekunyepedzera kuve wakachengeterwa varwere vane chirwere chekurambidzwa kana chinoda madhiri epamusoro eiyo norepinephrine (kuderedza bhegi shanduko).
Sarudza imwe chete dosing nzira. Simbisai Norepinephrine Influsion Service seyakaenderana nehuremu hwemuviri (Mcg / min) kana pasina (mcg / min) kuderedza njodzi yekukanganisa. Nharaunda yeAmerica yehutano hwehutano mishonga Zvimwe zvipatara zvinogona kutamira madhiri kune micrograms paminiti zvichienderana nedzidziso yechiremba - zvese zvinogamuchirika, asi zviviri zvinoratidzira zvisarudzo zvisingatenderwe.
Inoda kuraira zvinoenderana neyakajairwa qualate template. Inoda norepinephrine influssion chirevo chekurongedza template ine minda inodiwa yekuwedzera (semuenzaniso Iyo default turnaround nguva inofanira kunge iri "Stat" kune aya mairairo kuti atore pamberi mumutsara we pharmacy.
Kudzikisira mirairo yemuromo. Gumira madhiri emuromo kune chaiyo emergency kana chiremba kana chiremba asingakwanisi kupinda kana kunyora oda zvemagetsi. Vanachiremba vanofanira kuita avo avo pachako kunze kwekunge paine mamiriro ekuwedzera.
Tenga mhinduro dzakagadzirirwa-dzakagadzirwa kana dziripo. Shandisa fungidziro yeiyo preemixed norepinephrine mhinduro kubva kuVagadziri vebato (sosi yechitatu) kuderedza kunonoka kurapwa, uye dzivisa kurapwa kwekugadzira mishonga.
kusiyanisa kusiyanisa. Kusiyanisa kutarisisa kwakasiyana nekuvaita vakasarudzika vasati varova.
Ipa zvakakwana adc rate mazinga. Stock kumusoro pane adc uye inopa zvakakwana norepinephrine infusions yekusangana nezvinodiwa murwere. Monitor yekushandisa uye gadzirisa mwero wakajairwa sezvazvinodiwa.
Gadzira maitiro e batch kugadziriswa uye / kana kuumbwa pane zvinodiwa. Nekuti zvinogona kutora nguva yekusanganisa isina kuvhurika kushamisika, mishonga inogona kushandisa nzira dzakasiyana siyana kuti dzirege kugadzirira nguva uye kuendesa kana mumidziyo isina chinhu mukati memaawa,
Imwe neimwe package / vial inoongororwa. Kuti udzivise zvikanganiso panguva yekugadzirira, kugovera, kuongorora barcode pane imwe neimwe norepinephrine infusion bag kana kugoverwa isati kugadzirira, kugoverwa, kana kuchengetedza muADC. Barcode anogona chete kushandiswa pamabhawa ayo akabatanidzwa zvakananga kune iyo package.
Tarisa uone chinyorwa pabhegi. Kana bhegi rakasimba-rakasimba rinoshandiswa panguva yekuita mitezo yekucheka, iyo norepinephrine influsion inofanira kubviswa kwenguva pfupi kubva muhomwe yekuedza. Nenzira imwe chete, isa bhegi rekudzivirira rakareruka pamusoro pekunyepedzera usati waedza nekuiisa muhombodo nekukurumidza mushure mekuedzwa.
Gadzira mirayiridzo. Simbisa nhungamiro (kana protocol) yekunyatsonaka yegumi yeiyo norepinephrine (kana kumwe kujairika mushonga) Kana zvichikwanisika, batanidza kurudziro kune iyo titration order mumishonga yekudzora rekodhi rekodhi (mar).
Shandisa pombi yakangwara. Yese norepinephrine infusions inoshungurudzwa uye ichishandisa smart influsion pombi yekudzikisira system (Ders) kuti vabatike kuti vabati vafambe vehutano vanokwanisa kureva, kuverenga, kana zvikanganiso zvehurongwa.
Gonesa kuenderana. Pazvinogoneka, gonesa bi-nzira smart infusion pombi inoenderana neyemagetsi rekodhi zvinyorwa. Kubatana kunobvumidza ma pombi yekuregererwa neisimpination infelusion yakarongedzwa neyechiremba (kanokwana pane kutanga kwegumi) uye zvakare kuwedzera ruzivo rweprock
Maka mitsetse uye tsvaga mapaipi. Label mutsara wega wega uri pamusoro pepombi uye padyo nepfungwa yekuwana murwere. Mukuwedzera, usati watanga kana kuchinja iyo norepinephrine bhegi kana muyeuchidzo wekutenderera kubva kumudziyo wekupinza kune pombi uye chengetedza kuti pombi / chiteshi uye nzira yekutonga yakarurama.
Gamuchira kuongororwa. Kana kutsva kutsva kunomiswa, kuongorora kwehunyanzvi (semuenzaniso barcode) kunodiwa kuti uone mushonga / mhinduro, kusimbisa zvinodhaka uye murwere.
Kumisa kunyengera. Kana murwere akagadzikana mukati memaawa maviri ekurega kubvisa norepinephrine infusion, funga nezvekuwana kurongeka kwekurapa kubva pakurapa chiremba. Kana kutsvagura kwakamiswa, pakarepo kudzima infusion kubva kumurwere, bvisa iyo pombi, uye kurasa kudzivisa kutarisira tsaona. Kuchena kunofanirawo kubviswa kubva kumurwere kana kutsvagina kukanganiswa kweanopfuura maawa maviri.
Gadza protocol yekuwedzera. Gadza iyo yekuwedzera protocol yekapfumo norepinephrine. Vanamukoti vanofanira kuziviswa pamusoro peiyi regimen, kusanganisira kurapwa ne phentolamine mesylate uye kudzivisa kutonhora kumanikidza nharaunda yakakanganisika, iyo inogona kuwedzera tishu kukuvara.
Ongorora maitiro ekuisa chegumi. Monitor Vashandi Kuteerana nezviratidzo zveNorepinephrine Infusion, protocol uye chaicho chiremba mudzidzisi, pamwe nematsimba emurwere. Mienzaniso yematanho anosanganisira kutevedzera neyekuisa ma parmeter anodikanwa kuti agadziriswe; kunonoka pakurapwa; shandisa madhiri akangwara ne ders inogoneswa (uye kuunganidza); tanga kufungidzira pane yakatarwa yakatarwa; Chration maererano neiyo yakafemerwa frequency uye inoratidzira paramita; Iyo smart pombi inokuzivisa iwe kuwanda uye rudzi rwechidhori, zvinyorwa zvegumi zvegumi (zvinofanirwa kufananidza shanduko dosi) uye kukuvara murwere panguva yekurapa.