News

Mubvunzo: Norepinephrine mushonga unowanikwa zvakanyanya unopinzwa mutsinga (IV) semushonga unoenderera mberi. Ivasopressor iyo inowanzonzi titrated kuchengetedza kukwana kwakakwana kweropa uye chinangwa chekuputira nhengo muvakuru vanorwara zvakanyanya uye vana vane hypotension yakanyanya kana kuvhunduka kunoramba kuripo pasinei nekugadzirisa mvura yakakwana. Kunyangwe zvikanganiso zvidiki mune titration kana dose, pamwe nekunonoka kurapwa, zvinogona kutungamirira kune njodzi mhedzisiro. The Multicenter Health System munguva pfupi yapfuura yakatumira ISMP migumisiro yezvinowanzokonzera kuongororwa (CCA) ye106 norepinephrine zvikanganiso zvakaitika muna 2020 uye 2021. Kuongorora zviitiko zvakawanda neCCA zvinobvumira masangano kuunganidza zvikonzero zvinowanzokonzera uye kukanganiswa kwehurongwa. Dhata kubva kuchirongwa chekuzivisa chesangano uye smart infusion pombi yakashandiswa kuona zvikanganiso zvingangoitika.
ISMP yakagamuchira mishumo gumi nenhanhatu ine chekuita nenoradrenaline muna 2020 na2021 kuburikidza neISMP National Medication Error Reporting Chirongwa (ISMP MERP). Chinenge chikamu chimwe muzvitatu cheiyi mishumo chine chokuita nengozi dzine chokuita namazita akafanana, mavara, kana kuti kurongedzerwa, asi hapana zvikanganiso zvakashumwa chaizvoizvo. Takaburitsa mishumo yezvinomwe zvikanganiso zvevarwere ve norepinephrine: zvikanganiso zvina dosing (Kubvumbi 16, 2020; Nyamavhuvhu 26, 2021; Kukadzi 24, 2022); kukanganisa kumwe kwekuisa pfungwa kusina kunaka; imwe kukanganisa kweiyo titration isiriyo yemushonga; kukanganisa kukanganiswa kwe norepinephrine infusion. Ese gumi nematanhatu ISMP mishumo yakawedzerwa kuCCA multicenter health system (n=106) uye mhedzisiro yakabatanidzwa (N=122) yenhanho yega yega mumaitiro ekushandisa zvinodhaka inoratidzwa pazasi. Iko kukanganisa kwakashumwa kunosanganisirwa kupa muenzaniso wezvimwe zvinowanzoitika.
Nyora. Takaona zvinhu zvakati wandei zvinokonzeresa zvine chekuita nekunyora zvikanganiso, zvinosanganisira kushandiswa kusingakodzeri kwemirairo yemuromo, kutsanangura norepinephrine pasina kushandisa mirairo seti, uye zvibodzwa zvisinganzwisisiki kana zvisina chokwadi uye / kana titration parameters (kunyanya kana seti yemirairo isingashandisi). Dzimwe nguva zvakatemerwa titration paramita dzakanyanya kuomarara kana kuti hazvigoneke (semuenzaniso, iyo yakatemwa increments yakakura kwazvo), zvichiita kuti zviomere vanamukoti kutevedzera kana vachiongorora BP yemurwere. Mune zvimwe zviitiko, vanachiremba vanogona kuraira kuyerwa-kwakavakirwa kana kusiri-kurema-kwakavakirwa doses, asi izvi dzimwe nguva zvinovhiringika. Izvi zvekunze-kwe-bhokisi kurongedzerwa kunowedzera mukana wevanodzika varapi vachikanganisa, kusanganisira zvikanganiso zvepombi yekuronga, sezvo maviri dosing sarudzo dziripo muraibhurari yepombi. Mukuwedzera, kunonoka kwakashumwa kunoda kujekeswa kwekuraira apo kuraira mirairo yaisanganisira kurema-kwakavakirwa uye kusiri-kurema-kwakavakirwa dosing mirayiridzo.
Chiremba anokumbira mukoti kuti anyore tsamba ye norepinephrine kumurwere ane BP isina kugadzikana. Mukoti akapinda mukurongeka sezvakarayirwa nachiremba nemuromo: 0.05 mcg / kg / min IV inotaridzirwa kune chinangwa chinoreva arterial pressure (MAP) pamusoro pe65 mmHg. Asi mirayiridzo yemishonga yechiremba inosanganisa kwete-kurema-based dose escalation nehuremu-based maximum dose: titrate pachiyero che 5 mcg / min maminitsi ose e5 kusvika kuhuwandu hwehuwandu hwe1.5 mcg / kg / min. Pombi yekupinza yakangwara yesangano haina kukwanisa kuita kuti mcg/min dose kusvika pahuremu hwepamusoro-based dose, mcg/kg/min. Vemishonga vaifanira kutarisa mirairidzo kuvanachiremba, izvo zvakaita kuti kunonoke kupa rubatsiro.
Gadzirira uye ugovere. Kukanganisa kwakawanda kwekugadzirira uye dosing kunokonzerwa nekuwanda kwemabasa emu pharmacy, kuwedzeredzwa nevashandi vezvemishonga vanoda huwandu hwekuisa pfungwa norepinephrine infusions (32 mg / 250 ml) (inowanikwa pa503B formulation pharmacies asi isingawanikwe munzvimbo dzese). zvinotungamirira kumabasa akawanda uye kuneta. Zvimwe zvinowanzokonzera kukanganisa kukanganisa zvinosanganisira zvinyorwa zve noradrenaline zvakavigwa mumabhegi akareruka uye kusanzwisisa kwevashandi vemishonga yekukurumidzira kugovera.
Kubatanidzwa kwe norepinephrine uye nicardipine mubhegi rakasviba reamber hakuna kunaka. Kune yakasviba infusions, iyo dosing system yakadhinda mavara maviri, imwe pabhegi rekupinza pachayo uye imwe kunze kwebhegi reamber. Norepinephrine infusions yakaiswa zvisingazivikanwi mumapakiti emamber akanyorwa kuti "nicardipine" isati yagoverwa chigadzirwa chekushandiswa nevarwere vakasiyana uye zvakasiyana. Mhosho hadzina kucherechedzwa isati yapihwa kana dosing. Murwere akabatwa nicardipine akapiwa norepinephrine asi haana kukonzera kukuvadza kwenguva refu.
administrative. Zvikanganiso zvakajairika zvinosanganisira dosi isiriyo kana kukanganisa kwekuisa pfungwa, kukanganisa mwero isiriyo, uye kukanganisa kusiri kwezvinodhaka. Zvizhinji zvezvikanganiso izvi zvinokonzerwa nehurongwa husina kunaka hwepombi yekupinza yakangwara, muchidimbu nekuda kwekuvapo kwekusarudzwa kwedosi muraibhurari yemishonga, zvese nekurema uye pasina iyo; zvikanganiso zvekuchengetedza; kubatanidza uye kubatanidzwazve kwekuvhiringidzwa kana kumiswa kupindira kune murwere kwakatanga kupinza kusina kunaka kana kuti haana kuisa mitsara uye haana kuitevera paanotanga kana kutangazve infusion. Chimwe chinhu chakakanganisika mumakamuri ekukurumidzira uye makamuri ekushanda, uye smart pombi inoenderana nemagetsi ehutano marekodhi (EHR) yakanga isipo. Kuwedzeredza kunotungamira mukukuvadzwa kwetishu kwakashumwawo.
Mukoti akarayira norepinephrine sezvinorayirwa pamwero we0.1 µg/kg/min. Panzvimbo pekugadzirisa pombi kuti ibudise 0.1 mcg/kg/min, mukoti akaronga pombi kuti ibudise 0.1 mcg/min. Somugumisiro, murwere akagamuchira 80 nguva shoma norepinephrine pane yakatemwa. Apo infusion yacho yakaderedzwa zvishoma nezvishoma uye yakasvika pachiyero che 1.5 µg/min, mukoti akatonga kuti akanga asvika pachiyero chepamusoro-chepamusoro che 1.5 µg/kg/min. Nemhaka yokuti murwere anoreva arterial pressure yakanga ichiri isina kujairika, yechipiri vasopressor yakawedzerwa.
Inventory uye kuchengetedza. Kukanganisa kwakawanda kunoitika kana uchizadza otomatiki dispense makabati (ADCs) kana kuchinja norepinephrine vials mumakodhi anekodhi. Chikonzero chikuru chemhosho dzezvinhu izvi zvakafanana kunyora uye kurongedza. Zvisinei, zvimwe zvikonzero zvinowanzoitika zvakaonekwawo, zvakadai semazinga akaderera ehutano hwe norepinephrine infusions paADC iyo yakanga isina kukwana kuzadzisa zvinodiwa nechipatara chekuchengetedza varwere, zvichiita kuti kurapwa kunonoke kana ma pharmacy aifanira kuita infusions nekuda kwekushaya simba. Kutadza kutarisisa bhakodhi yechigadzirwa chega chega chenorepinephrine uchichengeta ADC ndechimwe chinowanzokonzera kukanganisa.
Mushandi wemishonga akazadzazve ADC nemushonga-yakagadzirirwa 32 mg/250 ml norepinephrine solution mudhirowa remugadziri re 4 mg/250 ml premix. Mukoti akasangana nechikanganiso paaiedza kugamuchira 4 mg/250 ml norepinephrine infusion kubva kuADC. Iyo barcode pane yega yega infusion haina kuongororwa isati yaiswa muADC. Apo mukoti akaziva kuti pakanga pane 32 mg / 250 ml chete bhegi muADC (inofanira kunge iri mufiriji chikamu cheADC), akakumbira kugadziriswa kwakarurama. Norepinephrine 4mg/250mL infusion solutions haiwanikwe muma pharmacy nekuda kwekushaikwa kwemugadziri we premixed 4mg/250mL packs, zvichikonzera kunonoka kusanganisa rubatsiro rwekupinza.
monitor. Kutariswa kwakashata kwevarwere, titration ye norepinephrine infusions kunze kwekuronga paramita, uye kusatarisira apo inotevera infusion bag inodiwa ndizvo zvinonyanya kukonzera kukanganisa kwekutarisa.
Murwere ari kufa ane mirairo yekuti "usamutsiridze" anobayiwa ne norepinephrine kuti agare kwenguva yakakwana kuti mhuri yake itaure zvakanaka. Iyo norepinephrine infusion yakapera, uye pakanga pasina bhegi rekusara muADC. Nurse akabva afonera pharmacy ndokukumbira bag idzva. Pharmacy yakashaya nguva yekugadzira mushonga murwere asati afa ndokuonekana nemhuri yake.
Danger. Njodzi dzese dzisina kukonzera kukanganisa dzinoshumwa kune ISMP uye dzinosanganisira mazita akafanana kana mazita ezvinodhaka. Mishumo yakawanda inoratidza kuti kurongedza uye kunyora kwezvakasiyana-siyana zve norepinephrine infusions inoparadzirwa ne503B outsourcers inoita seyakada kufanana.
Zvinokurudzirwa kuita zvakachengeteka. Funga zvinotevera kurudziro paunenge uchigadzira kana kudzokorora zano renzvimbo yako kuderedza zvikanganiso mukushandiswa kwakachengeteka kwenorepinephrine (uye imwe vasopressor) infusions:
limit concentration. Yakamisikidzwa yehuwandu hushoma hwekutarisisa kurapwa kwevana uye / kana varwere vakuru. Rondedzera uremu hwemuganho weiyo yakanyanya kuwanda infusion kuti ichengeterwe varwere vane kurambidzwa kwemvura kana kuti inoda madosi epamusoro enorepinephrine (kuderedza shanduko yebhegi).
Sarudza imwe dosing nzira. Gadzirisa norepinephrine infusion prescriptions zvichienderana nehuremu hwemuviri (mcg/kg/min) kana pasina (mcg/min) kuderedza njodzi yekukanganisa. IAmerican Society of Health System Pharmacists (ASHP) Safety Standards Initiative4 inokurudzira kushandiswa kwe norepinephrine dosage units mu micrograms/kg/miniti. Zvimwe zvipatara zvinogona kuenzanisa dosi kune micrograms paminiti zvichienderana nezvinodiwa nachiremba - zvose zvinogamuchirwa, asi nzira mbiri dzedosing hazvibvumirwi.
Inoda kunyorerwa zvinoenderana neyakajairwa odha template. Inoda norepinephrine infusion prescription uchishandisa yakajairwa kuodha template ine minda inodiwa yekumisikidzwa kwaunoda, inoyerwa titration tarisiro (semuenzaniso, SBP, systolic blood pressure), titration parameters (semuenzaniso, kutanga dhigirii, dhamu renji, chikamu chekuwedzera, uye dosing frequency) kumusoro. kana pasi ), nzira yehutungamiri uye chiyero chepamusoro chisingafaniri kudarika uye / kana chiremba anoenda anofanira kudanwa. Nguva yekuchinja yagara iripo inofanirwa kunge iri "stat" yekuti maodha aya atore pamberi pemutsetse wemuchitoro chemishonga.
Deredza mirairo yemuromo. Deredza mirairo yemuromo kune chaiyo yekukurumidzira kana apo chiremba asingakwanisi kupinda kana kunyora odha nemagetsi. Vanachiremba vanofanira kuita gadziriro dzavo vamene kunze kwokunge paine migariro inorerutsira.
Tenga zvigadziriso zvakagadzirirwa kana zviripo. Shandisa zvakagadziriswa zve premixed norepinephrine mhinduro kubva kune vanogadzira uye / kana mhinduro dzakagadzirirwa nevechitatu-party vatengesi (zvakadai se503B) kuderedza nguva yekugadzirira pharmacy, kuderedza kunonoka kurapwa, uye kudzivisa zvikanganiso zvekugadzira pharmacy.
differential concentration. Kusiyanisa kutarisisa kwakasiyana nekuita kuti ive mutsauko usati watora dosing.
Ipa mazinga akakwana eADC rate. Chengetedza paADC uye upe yakakwana norepinephrine infusions kuti isangane nezvinodiwa nevarwere. Tarisa mashandisirwo uye gadzirisa mwero mwero sezvinodiwa.
Gadzira maitiro ekugadzirisa batch uye / kana kusanganisa pane zvinodiwa. Nekuti zvinogona kutora nguva kusanganisa iyo isina kudzikinurwa yakanyanya kuwanda, ma pharmacy anogona kushandisa nzira dzakasiyana-siyana kukoshesa kugadzirira nenguva uye kuendesa, kusanganisira dosing uye / kana kumanikidza kana midziyo isina chinhu mukati meawa, zvichikurudzirwa nepoindi yekutarisira kana email zviziviso zvinofanirwa kuve. yakagadzirirwa.
Imwe neimwe package/vial inotariswa. Kuti udzivise zvikanganiso panguva yekugadzirira, kugovera, kana kuchengetedza, tarisa bhakodhi pane yega yega norepinephrine infusion bag kana vial kuti ionekwe pamberi pekugadzirira, kugovera, kana kuchengetedza muADC. Mabhakodhi anongo shandiswa pamavara anonamirwa zvakananga pasuru.
Tarisa chikwangwani pabhegi. Kana bhegi rakasimba rinoshandiswa panguva yekuongorora dosing, iyo norepinephrine infusion inofanira kubviswa kwenguva pfupi kubva mubhegi kuti iongororwe. Neimwe nzira, isa bhegi rekudzivirira rakareruka pamusoro peiyo infusion usati waedza uye woiisa mubhegi nekukurumidza mushure mekuyedzwa.
Gadzira nhungamiro. Gadzira nhungamiro (kana protocol) yekupinza titration ye norepinephrine (kana imwe dhizaini yakanyorwa), kusanganisira yakajairwa, yakachengeteka dhasi renji, yakajairika titration dose increments, titration frequency (maminetsi), yakanyanya dose / mwero, yekutanga, uye kutarisa kunodiwa. Kana zvichibvira, batanidza kurudziro kune iyo titration order muMedicines Regulatory Record (MAR).
Shandisa pombi yakangwara. Yese infusions ye norepinephrine inopinzwa uye yakadhindwa pachishandiswa smart infusion pombi ine Dose Error Reduction System (DERS) inogoneswa kuitira kuti DERS igone kuzivisa nyanzvi dzehutano kune zvinogona kurongera, kuverenga, kana zvikanganiso zvehurongwa.
Gonesa Kugarisana. Pazvinogoneka, gonesa bi-directional smart infusion pombi inoenderana nemagetsi marekodhi ehutano. Kudyidzana kunobvumira mapombi kuti atange azadzwa neakasimbiswa infusion marongero anotemerwa nachiremba (zvirinani pakutanga kwetitration) uye zvakare kunowedzera ruzivo rwemufesi rwekuti yakawanda sei yasara mune titrated infusions.
Maka mitsetse uye tsvaga mapaipi. Nyora mutsetse wega wega wekupinzwa pamusoro pepombi uye pedyo nenzvimbo yekupinda nemurwere. Pamusoro pezvo, usati watanga kana kushandura bhegi renorepinephrine kana infusion rate, nemaoko fambisa tubing kubva mugaba remhinduro kuenda papombi uye murwere kuti uone kuti pombi / chiteshi uye nzira yekutonga ndeyechokwadi.
Bvuma kuongororwa. Kana kuisirwa kutsva kwamiswa, kuongororwa kwehunyanzvi (semuenzaniso bhakodhi) kunodiwa kuti kuonekwe kuti mushonga/mushonga wacho, uwandu hwezvinodhaka uye murwere.
Rega kupinza. Kana murwere akagadzikana mukati meawa maviri ekurega kuvharwa kwe norepinephrine, funga kuwana murairo wekurega kubva kuna chiremba wekurapa. Kana iyo infusion yamira, pakarepo bvisa infusion kubva kumurwere, ibvise kubva papombi, uye urase kuti udzivise kutonga netsaona. Iyo infusion inofanirawo kubviswa kubva kumurwere kana iyo infusion ikakanganiswa kweanopfuura maawa maviri.
Gadzira iyo extravasation protocol. Rongedza extravasation protocol ye frothing norepinephrine. Vanamukoti vanofanira kuziviswa nezvechirongwa ichi, kusanganisira kurapwa ne phentolamine mesylate uye kudzivirira kutonhora kwenzvimbo yakakanganiswa, izvo zvinogona kuwedzera kukuvara kwenyama.
Ongorora maitiro ekunyora. Chengetedza kutevedza kwevashandi nekurudziro ye norepinephrine infusion, maprotocol uye zvakanangana nemirairo yechiremba, pamwe nemhedzisiro yemurwere. Mienzaniso yezviyero inosanganisira kutevedzera mitsara yetitration inodiwa pakurongeka; kunonoka kurapwa; kushandiswa kwemapombi akangwara ane DERS akagoneswa (uye kudyidzana); tanga infusion panguva yakatarwa; titration zvinoenderana neyakatemerwa frequency uye dosing paramita; iyo smart pombi inokuzivisa iwe nezve frequency uye rudzi rwedosi, zvinyorwa zvetitration paramita (inofanirwa kuenzanisa shanduko yedosi) uye kukuvadza kwemurwere panguva yekurapa.