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ABSTRACT Aims and Objectives Design Methods Results Conclusions Relevance to Clinical Practice Evaluate the effect of IV line labels on nurses' identification of high‐alert medications in a simulated scenario of multiple infusions for critically ill patients.Randomised crossover simulation experimental study.A study was conducted on 29 nurses working in intensive care for over 6 months. They were given two critical scenarios in a simulated environment, one with labels and the other without labels, involving multiple intravenous infusions. The nurses had to identify the medications infused into the critical patients' intravenous lines and disconnect a specific line. The data were collected and analysed to evaluate the errors made by the nurses in identifying and disconnecting the medications and the time they spent carrying out the tasks. The Wilcoxon test was used to analyse the variation in outcome before and after the intervention.Approximately one‐third of the study participants incorrectly identified the intravenous lines in both scenarios. There was no significant difference in the average number of errors between the scenarios with and without labels. However, the time taken to perform the tasks in the scenario with labels was 1 min less than in the scenario without labels, suggesting a potential efficiency gain.The labels on the intravenous lines allowed for quick drug identification and disconnection. The professionals performed similarly in correctly recognising the high‐alert medication intravenous lines, in the scenarios with or without labels.The label can be used as a technology to prevent misidentification of high‐alert medications administered to critically ill patients through intravenous lines, thereby enhancing medication safety in healthcare institutions.No Public Contribution. [ABSTRACT FROM AUTHOR]

In clinical practice, the application of surface disinfectants for skin disinfection is a prerequisite for venipuncture. Chlorhexidine, a widely recognized disinfectant, is frequently employed for this purpose. However, during intravenous infusions, minute quantities of chlorhexidine can be inadvertently introduced into the bloodstream via the puncture needle, potentially precipitating immediate-type (type) hypersensitivity reactions. Regrettably, these reactions are often erroneously attributed to administered medications, such as antibiotics, which can result in both misdiagnosis and underdiagnosis. This article details a case of an allergic reaction that occurred subsequent to multiple intravenous infusions and was ultimately identified as chlorhexidine-induced after antibiotic allergy was ruled out. The objective of this report is to deepen the clinical physcians’ comprehension of chlorhexidine-induced allergies in the context of infusion-related allergic reactions, thereby offering a valuable reference for accurate diagnosis and effective treatment strategies. [ABSTRACT FROM AUTHOR]

Background: This study aims to compare resource utilization and staff satisfaction between the point-of-care (POC) activated system and the traditional intravenous piggyback (PB) system in hospital pharmacy settings. Methods: Employing a pre-post quasi-experimental design from November 2019 to April 2020, the study assessed resource requirements for both the POC activated system and the traditional PB system. Additionally, a staff satisfaction survey was conducted, focusing on staff experiences related to the pharmacy preparation process and the subsequent activation of the system by nurses. Results: The POC activated system required significantly fewer full-time equivalents (FTEs) per month compared to the PB system (0.36 ± 0.05 vs. 1.56 ± 0.07; p < 0.0001). Using POC in automated dispensing cabinets (ADCs) reduced medication administration time and returns (6.41% vs. 1.75%; p < 0.0001). The staff satisfaction survey revealed greater satisfaction with the POC activated system. A subsequent analysis showed the POC activated system had a low expiration rate of 0.1% and a cost of 39 Saudi riyal, while the traditional system had higher expiration rates and cost of 46,260 SR. Conclusions: The POC activated system reduced FTEs, decreased returned medications, and enhanced staff satisfaction compared to the PB system. [ABSTRACT FROM AUTHOR]

In clinical practice， the application of surface disinfectants for skin disinfection is a prerequisite for venipuncture. Chlorhexidine， a widely recognized disinfectant， is frequently employed for this purpose. However， during intravenous infusions， minute quantities of chlorhexidine can be inadvertently introduced into the bloodstream via the puncture needle， potentially precipitating immediate-type （type ） hypersensitivity reactions. Regrettably， these reactions are often erroneously attributed to administered medications， such as antibiotics， which can result in both misdiagnosis and underdiagnosis. This article details a case of an allergic reaction that occurred subsequent to multiple intravenous infusions and was ultimately identified as chlorhexidine-induced after antibiotic allergy was ruled out. The objective of this report is to deepen the clinical physcians’ comprehension of chlorhexidine-induced allergies in the context of infusion-related allergic reactions， thereby offering a valuable reference for accurate diagnosis and effective treatment strategies.

Objective To determine the effects of Dextrose 5% for maintenance and creep fluids on cumulative fluid balance (CFB) for septic shock concerning adult people.Design An open-label randomized clinical trial with a single center and parallel groups.Setting ICUs of a tertiary care academic medical center.Patients Adult individuals who have developed septic shock as described by the Sepsis 3 criteria.Interventions Dextrose 5% (n = 50) versus Saline 0.9% (n = 50) for maintenance and creep fluid for 72 hours.Main variables of interest The primary outcome measured was the CFB at 72 hours. Secondary outcomes assessed included mortality within 28 days, the number of days patients were free from (coma and delirium, ICU, mechanical ventilation, vasopressors), the occurrence of acute kidney injury, and disturbances in electrolyte levels.Results The CFB was significantly lower in Dextrose group vs Saline group (4.46 versus 6.75 L, median difference; −2.06 L; 95% CI, −2.63 to −1.35; p = P

Objective: To determine the effects of Dextrose 5% for maintenance and creep fluids on cumulative fluid balance (CFB) for septic shock concerning adult people. Design: An open-label randomized clinical trial with a single center and parallel groups. Setting: ICUs of a tertiary care academic medical center. Patients: Adult individuals who have developed septic shock as described by the Sepsis 3 criteria. Interventions: Dextrose 5% (n = 50) versus Saline 0.9% (n = 50) for maintenance and creep fluid for 72 hours. Main variables of interest: The primary outcome measured was the CFB at 72 hours. Secondary outcomes assessed included mortality within 28 days, the number of days patients were free from (coma and delirium, ICU, mechanical ventilation, vasopressors), the occurrence of acute kidney injury, and disturbances in electrolyte levels. Results: The CFB was significantly lower in Dextrose group vs Saline group (4.46 versus 6.75 L, median difference; −2.06 L; 95% CI, −2.63 to −1.35; p = P < 0.001). No significant difference mortality within 28 days (32% in the Dextrose vs 42% in the saline group; hazard ratio, 0.7; 95% CI, 0.36 to 1.34, p = 0.28). The proportions of patients with hyponatremia were higher in the Dextrose than the Saline group (31% versus 0%, p < 0.001). Conclusions: Particularly in cases of septic shock, maintenance and creep fluids with Dextrose 5% as compared to Saline 0.9% resulted in a significantly lower CFB at 72 hours. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to organize a training program for nursing students using the peer teaching method between seniors and juniors and to investigate its effects on self-confidence, skill performance ability, and self-directed learning ability. Methods: A non-equivalent control group pretest-posttest design was used. The study population comprised 76 nursing students (experimental group, n=37; control group, n=39) from two universities. The experimental group received four training sessions of 2 hours each, during which peer teaching was applied between seniors and juniors. Data were collected between September 4 and September 15, 2023 and analyzed using SPSS for Windows version 28.0. Results: Compared with the control group, the experimental group exhibited significant increases in self-confidence (t=4.36, p<.001), skill performance ability (t=4.74, p<.001), and self-directed learning ability (t=2.25, p=.027). Conclusion: Peer teaching between seniors and juniors was found to be an effective tool in nursing education to cultivate nursing students' skill performance confidence, skill performance ability, and self-directed learning ability. The findings of this study can guide nursing professors in designing and implementing educational programs that incorporate peer teaching between seniors and juniors. Future studies should continue to apply peer teaching to nursing education programs and evaluate its effectiveness. [ABSTRACT FROM AUTHOR]

Background: Multiple medications are more effective than single agents for postoperative pain management. We investigated the analgesic effects of an intravenous combination of acetaminophen and ibuprofen immediately after thyroidectomy. Methods: In this double‐blind clinical trial, 62 patients who underwent thyroidectomies were randomized to either the treatment (1000 mg acetaminophen, 300 mg ibuprofen) or control (1000 mg acetaminophen) group. Postoperative pain intensity was assessed using the visual analog scale (VAS) 0, 15, and 30 min after recovery room admission. Opioid rescue consumption was also recorded. Results: The VAS scores were significantly lower in the treatment than in the control group 15 [3 (2–4.3) vs. 5 (3–6); p = 0.015] and 30 [3 (2–4.3) vs. 4 (3–5); p = 0.018] min after recovery room admission, as were the opioid rescue dose requirements (p = 0.033). Conclusions: Combined intravenous acetaminophen and ibuprofen may be better than acetaminophen alone for immediately acute postoperative pain after thyroidectomy. [ABSTRACT FROM AUTHOR]

Background: Biologic drugs are highly effective for inflammatory bowel disease (IBD) management but are key drivers of costs of care especially when administered intravenously (i.v.). Availability of subcutaneous (SC) formulations has increased convenience for patients and improved access to care, but at the cost of revenue to health services. Aims: To evaluate the economic impact of transitioning a tertiary centre IBD cohort from i.v. to SC biologic administration and assess the implications for key stakeholders. Methods: A retrospective analysis of all patients who received i.v. infliximab or vedolizumab in the outpatient infusion centre of a tertiary IBD centre between July 2019 and June 2021 was undertaken. Data were collated from electronic medical records, pharmacy dispensing systems and the hospital business intelligence unit. An economic analysis and theoretical financial/capacity impact analysis of a transition to an SC model were estimated under two scenarios using a random 10% and 30% of the patient cohort. Results: Transitioning our IBD cohort from i.v. to SC administration would result in a loss to our health service of AU$2 732 123.75, composed of AU$1 463 003.75 in Weighted Inlier Equivalent Separation (WIES) and AU$1 269 120 in drug procurement revenue. However, it would ease capacity in the infusion centre by up to 5256 h. Conclusions: Transitioning patients to SC administration results in improved access to infusion centres and substantial savings to state governments; however, switching results in a loss of i.v. biologic‐generated WIES to health services. Alternative funding models are required to achieve sustainability in IBD care and reduce reliance on i.v. biologic‐generated income. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Intravenous (IV) fluid therapy is a known source of iatrogenic complications. Guideline implementation can be used to educate and guide physicians on adequate fluid management. In the emergency department (ED), a complex and interruption-driven environment, workload is high and active documentation is required to facilitate audits of fluid management quality. PATIENTS AND METHODS: Fluid management was evaluated in the ED records of adult non-critically ill patients admitted to a tertiary care center before (PRE: 1/12/2016-31/3/2017) and after (POST: 1/12/2018-31/3/2019) implementation of an educational intervention aiming to optimize IV fluid therapy in November 2018. First, the appropriateness of the 24-hour IV maintenance fluid prescription was evaluated, as prescribed by the emergency physician. Second, factors associated with appropriate prescribing were assessed, as well as the quality of fluid management documentation practice. Prescription appropriateness and documentation quality were evaluated retrospectively using a structured audit instrument and additional review by experts. RESULTS: A total of 237 patients (2.3%) were included in the PRE-intervention group and 253 patients (2.4%) in the POST-intervention group. The expert panel evaluated 214 prescriptions in 82.3% of patients (PRE: 99, POST: 115), and appropriateness increased significantly (19.2% vs. 61.2%, p=0.002). A higher odds of an appropriate IV maintenance fluid prescription was determined, attributed to the intervention (adjOR=2.580; 95% CI 1.363-4.884) and in patients having a prehospital intervention (adjOR=1.914, 95% CI 1.022-3.586). Appropriateness of fluid management documentation did not significantly improve after the implementation of the intervention (15.6% vs. 16.2%, p=0.858). CONCLUSIONS: The IV fluid prescriptions’ appropriateness was significantly higher after guideline implementation. However, documentation quality of fluid management was poor in the studied ED records. Active stewardship programs are warranted to further monitor fluid management quality in the ED. [ABSTRACT FROM AUTHOR]

Myelodysplastic syndromes (MDSs) are variations of bone marrow failure disorders that lead to insufficient production of healthy blood cells culminating in some combination of low red blood cells, low white cells, or both. This case report presents a case of increased hemoglobin levels following intravenous (IV) nutrient therapy. J.B. is a 74-year-old male who presented with a chief concern of MDS. He was experiencing extreme fatigue and exhaustion, episodes of shortness of breath and a decline in hemoglobin levels. He was being followed by a hematologist who monitored his complete blood count (CBC) at regular intervals, with primary focus on blood hemoglobin. His hemoglobin levels were significantly lower than the normal range, but never met the threshold for a blood transfusion (< 75 g/dL), his only treatment option. Beginning in November 2021, weekly to biweekly IV nutrient therapy treatments were initiated. In all, 39 IV treatments were given until August 2023. Intravenous nutrient formulas included Myer's Cocktail, high-dose vitamin C (25 g), Hydrating Myer's Cocktail and Hydrating Myer's Cocktail + glutathione. As IV treatments were administered, a trend was observed showing a consistent improvement of hemoglobin levels over time, with the greatest degree of improvement observed after the series of Hydrating Myer's Cocktails. The patient also reported decreased overall fatigue and reduced recovery time from activity. Delivering a series of IV infusions may have resulted in an improvement of hemoglobin levels in this patient. Further investigation is warranted to understand the potential effects IV nutrient therapy could have on MDS patients with a similar prognosis. [ABSTRACT FROM AUTHOR]

Objective: to identify and compare the practice of Nursing professionals regarding the insertion of peripheral vascular access devices, according to professional category. Method: descriptive sectional study carried out between July 2021 and May 2022 with 2,584 Nursing professionals, using a questionnaire validated by three judges with expertise in intravenous therapy, containing variables related to catheterization and the vascular access device. Descriptive and inferential analysis was carried out. Results: most professionals do not prepare the patient or perform some essential care before attempting peripheral intravenous catheterization. Regarding the preferred catheterization site, hands, arm and forearm stand out. There is no control over the tourniquet time, and the patient is punctured more than three times. The most used device materials are polyurethane and Teflon ® , more than one criterion is adopted for device selection, and Micropore ® type adhesive tape was the covering most cited by Nursing professionals. The identification of catheterization was not adequate. Conclusion: Nursing technicians and assistants are the professionals who least comply with what is recommended in recognized guidelines. Nurses’ practice also presents deviations from scientific evidence.

Objective: to analyze the occurrence of difficulty in the peripheral insertion of the central catheter and the presence of complications in the use of this device in hospitalized adults who received peripheral intravenous therapy through a short peripheral intravenous catheter and to identify whether there is an association between peripheral intravenous therapy and the presence of complications in the use of the peripherally inserted central catheter. Method: retrospective cohort, with patients aged 18 years or over, in a tertiary teaching hospital, with a peripherally inserted central catheter, who had at least one previous short peripheral intravenous catheter. Data were analyzed using descriptive statistics and Poisson regression. Results: the sample consisted of 76 patients. There was an association between difficulty in the insertion procedure and number of punctures (p

Vancomycin is a frequently used antibiotic in intensive care units, and the patient's renal clearance affects the pharmacokinetic characteristics of vancomycin. Several advantages have been reported for vancomycin continuous intravenous infusion, but studies on continuous dosing regimens based on patients' renal clearance are insufficient. The aim of this study was to develop a vancomycin serum concentration prediction model by factoring in a patient's renal clearance. Children admitted to our institution between July 1, 2021, and July 31, 2022 with records of continuous infusion of vancomycin were included in the study. Sex, age, height, weight, vancomycin dose by weight, interval from the start of vancomycin administration to the time of therapeutic drug monitoring sampling, and vancomycin serum concentrations were analyzed with the linear regression analysis of the mixed effect model. Univariable regression analysis was performed using the vancomycin serum concentration as a dependent variable. It showed that vancomycin dose (p < 0.001) and serum creatinine (p = 0.007) were factors that had the most impact on vancomycin serum concentration. Vancomycin serum concentration was affected by vancomycin dose (p < 0.001) and serum creatinine (p = 0.001) with statistical significance, and a multivariable regression model was obtained as follows: Vancomycin serum concentration (mg/l) = -1.296 + 0.281 × vancomycin dose (mg/kg) + 20.458 × serum creatinine (mg/dl) (adjusted coefficient of determination, R2 = 0.66). This prediction model is expected to contribute to establishing an optimal continuous infusion regimen for vancomycin. [ABSTRACT FROM AUTHOR]

Introduction: The objective of this study was to compare the continuous infusion of cefepime with the intermittent infusion in patients with sepsis caused by Gram-negative bacilli (GNB). Methods: Randomized 1:1 multicenter double-blinded placebo-controlled study with allocation concealment; multicenter study in the intensive care units of Colombia. Patients with sepsis, severe sepsis or septic shock, and GNB-suspected bacteremia. Cefepime was administered for 7 to 14 days over 30 m intermittently every 8 h over 24 h plus continuous saline solution (0.9%) (G1) or 3 g administered continuously plus saline solution every 8 h (0.9%) (G2). The percentage of clinical response at 3, 7, and 14 days, relapse at 28 days, and mortality at discharge were measured. Results: The recruitment was stopped at the suggestion of the Institutional Review Board (IRB) following an FDA alert about cefepime. Thirty-two patients were randomized; 25 received the intervention, and GNB bacteremia was confirmed in 16 (9 G1 and 7 G2). Favorable clinical response in days 3, 7, and 14 was 88.8%, 88.8%, and 77.8% (G1) and was similar for G2 (85.7%). There were no relapses or deaths in G2, while in G1, one relapse and two deaths were observed. Conclusions: The results of this study support the use of cefepime for the treatment of Gram-negative infections in critically ill patients, but we could not demonstrate differences between continuous or intermittent administration because of the small sample size, given the early suspension of the study. [ABSTRACT FROM AUTHOR]

Background: This study aims to compare resource utilization and staff satisfaction between the point-of-care (POC) activated system and the traditional intravenous piggyback (PB) system in hospital pharmacy settings. Methods: Employing a pre-post quasi-experimental design from November 2019 to April 2020, the study assessed resource requirements for both the POC activated system and the traditional PB system. Additionally, a staff satisfaction survey was conducted, focusing on staff experiences related to the pharmacy preparation process and the subsequent activation of the system by nurses. Results: The POC activated system required significantly fewer full-time equivalents (FTEs) per month compared to the PB system (0.36 ± 0.05 vs. 1.56 ± 0.07; p < 0.0001). Using POC in automated dispensing cabinets (ADCs) reduced medication administration time and returns (6.41% vs. 1.75%; p < 0.0001). The staff satisfaction survey revealed greater satisfaction with the POC activated system. A subsequent analysis showed the POC activated system had a low expiration rate of 0.1% and a cost of 39 Saudi riyal, while the traditional system had higher expiration rates and cost of 46,260 SR. Conclusions: The POC activated system reduced FTEs, decreased returned medications, and enhanced staff satisfaction compared to the PB system.

Introduction: Nipocalimab is a high-affinity, fully human, aglycosylated, effectorless, immunoglobulin G (IgG) 1 monoclonal antibody that targets the neonatal Fc receptor (FcRn), decreases systemic IgG including autoantibodies, and is under development in several IgG autoantibody- and alloantibodymediated diseases, including generalized myasthenia gravis, chronic inflammatory demyelinating polyneuropathy, maternal-fetal medicine, and multiple other therapeutic areas. An initial phase 1 study with single and multiple ascending doses of nipocalimab infused intravenously (IV) over 2 h demonstrated dose-dependent serum pharmacokinetics and IgG reductions, with an adverse event (AE) profile comparable to placebo. Methods: The current investigation evaluates the safety, tolerability, pharmacokinetics, and pharmacodynamics of single doses of nipocalimab across various IV infusion rates in a randomized, double-blind, placebocontrolled, sequential-dose study. Forty participants were randomized to receive nipocalimab 30 mg/kg over 60, 30, 15 or 7.5 min (0.5, 1, 2, or 4 mg/kg/min); nipocalimab 60 mg/kg over 15 min (4 mg/kg/min); or matching placebo. Results: At doses up to 60 mg/kg and infusion rates up to 4 mg/kg/min (maximum clinically feasible rate), single doses of nipocalimab were tolerable, with 12 (40%) participants experiencing AEs across nipocalimab cohorts compared with 1 (10%) participant in the placebo cohort. AEs deemed treatment related occurred in 6 (20%) participants receiving nipocalimab and 1 (10%) participant receiving placebo. None of the AEs were severe, and no participants discontinued treatment due to AEs. Nipocalimab provided consistent, dose-dependent serum pharmacokinetics and IgG reductions, regardless of infusion rate. Discussion: This study supports the use of shortened durations of nipocalimab infusion for future studies. [ABSTRACT FROM AUTHOR]

IntroductionNipocalimab is a high-affinity, fully human, aglycosylated, effectorless, immunoglobulin G (IgG) 1 monoclonal antibody that targets the neonatal Fc receptor (FcRn), decreases systemic IgG including autoantibodies, and is under development in several IgG autoantibody- and alloantibody-mediated diseases, including generalized myasthenia gravis, chronic inflammatory demyelinating polyneuropathy, maternal-fetal medicine, and multiple other therapeutic areas. An initial phase 1 study with single and multiple ascending doses of nipocalimab infused intravenously (IV) over 2 h demonstrated dose-dependent serum pharmacokinetics and IgG reductions, with an adverse event (AE) profile comparable to placebo.MethodsThe current investigation evaluates the safety, tolerability, pharmacokinetics, and pharmacodynamics of single doses of nipocalimab across various IV infusion rates in a randomized, double-blind, placebo-controlled, sequential-dose study. Forty participants were randomized to receive nipocalimab 30 mg/kg over 60, 30, 15 or 7.5 min (0.5, 1, 2, or 4 mg/kg/min); nipocalimab 60 mg/kg over 15 min (4 mg/kg/min); or matching placebo.ResultsAt doses up to 60 mg/kg and infusion rates up to 4 mg/kg/min (maximum clinically feasible rate), single doses of nipocalimab were tolerable, with 12 (40%) participants experiencing AEs across nipocalimab cohorts compared with 1 (10%) participant in the placebo cohort. AEs deemed treatment related occurred in 6 (20%) participants receiving nipocalimab and 1 (10%) participant receiving placebo. None of the AEs were severe, and no participants discontinued treatment due to AEs. Nipocalimab provided consistent, dose-dependent serum pharmacokinetics and IgG reductions, regardless of infusion rate.DiscussionThis study supports the use of shortened durations of nipocalimab infusion for future studies.

Contamination of blood samples from patients receiving intravenous fluids is a common error with potential risk to the patient. Algorithms based on the presence of aberrant results have been described but have the limitation that not all infusion fluids have the same composition. Our objective is to develop an algorithm based on the detection of the dilution observed on the analytes not usually included in infusion fluids. A group of 89 cases was selected from samples flagged as contaminated. Contamination was confirmed by reviewing the clinical history and comparing the results with previous and subsequent samples. A control group with similar characteristics was selected. Eleven common biochemical parameters not usually included in infusion fluids and with low intraindividual variability were selected. The dilution in relation to the immediate previous results was calculated for each analyte and a global indicator, defined as the percentage of analytes with significant dilution, was calculated. ROC curves were used to define the cut-off points. A cut-off point of 20 % of dilutional effect requiring also a 60 % dilutional ratio achieved a high specificity (95 % CI 91–98 %) with an adequate sensitivity (64 % CI 54–74 %). The Area Under Curve obtained was 0.867 (95 % CI 0.819–0.915). Our algorithm based on the global dilutional effect presents a similar sensitivity but greater specificity than the systems based on alarming results. The implementation of this algorithm in the laboratory information systems may facilitate the automated detection of contaminated samples. [ABSTRACT FROM AUTHOR]

Abstract Aim To systematically evaluate the efficacy of different topical treatments for PVC‐related phlebitis in hospital in‐patients. Design A systematic review and meta‐analysis. Methods A selection was made of experimental and quasi‐experimental studies published in English or Spanish. These should provide data on the degree of phlebitis, pain and infiltration (means and standard deviations, mainly) of hospitalized patients with phlebitis secondary to peripheral venous catheter. All those studies that reflected systemic or exclusive prevention treatments were excluded. Searches were from inception to April 2020. The date of data collection was from December 2020 to May 2021. The selection criteria were based on the PICOS model. Risk of bias was assessed using the Cochrane Collaboration tool. Results Twelve studies (726 patients) met the inclusion criteria. With respect to the decrease in the degree of phlebitis, was found ichthammol glycerine, followed by heparinoids. As for degree of pain, sesame oil obtained the most marked reduction. In terms of degree of infiltration, heparinoids and ichthammol glycerine were the only products to achieve a statistically significant reduction. The most important limitations are the low quantity and quality of the trials included. Insufficient data are available to draw valid conclusions about the efficacy of any treatment.

Resumen: Introducción: La fluidoterapia intravenosa es un tratamiento ampliamente utilizado en pacientes pediátricos hospitalizados. El objetivo del estudio fue analizar las complicaciones asociadas al uso de sueros isotónicos de mantenimiento en pacientes hospitalizados y comparar la frecuencia de aparición de estas complicaciones con distintos ritmos de administración. Materiales y métodos: Se realizó un estudio observacional y prospectivo, en el que se incluyeron pacientes hospitalizados de entre tres meses y 15 años de edad que recibieron tratamiento con fluidoterapia isotónica 0,9% con glucosa al 5% durante las primeras 24 horas de ingreso. Se dividieron en dos cohortes según el ritmo de fluidoterapia: restringido 110 mEq/L (16,6%) y edemas (19%). La aparición de edemas fue más frecuente en pacientes de menor edad (p 110 mEq/L (16.6%) and oedema (19%). Oedema was more frequent in patients with lower age (p

Jeongok Park,1 Sang Bin You,2 Hyejin Kim,3 Cheolmin Park,4 Gi Wook Ryu,5 Seongae Kwon,2 Youngkyung Kim,6 Sejeong Lee,6 Kayoung Lee7 1Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, Seoul, South Korea; 2Yonsei University College of Nursing, Seoul, South Korea; 3Severance Hospital, Yonsei University Health System, Seoul, South Korea; 4Department of Materials Science and Engineering, Yonsei University, Seoul, South Korea; 5Department of Nursing, Hansei University, Gunpo-si, South Korea; 6College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, South Korea; 7Gachon University College of Nursing, Incheon, South KoreaCorrespondence: Kayoung Lee, Gachon University College of Nursing, 191 Hambakmoero, Yeonsu-gu, Incheon, 21936, South Korea, Tel +82-32-820-4227, Email kayolee@gachon.ac.krPurpose: Medication administration is a complex process and constitutes a substantial component of nursing practice that is closely linked to patient safety. Although intravenous fluid administration is one of the most frequently performed nursing tasks, nurses’ experiences with intravenous rate control have not been adequately studied. This study aimed to explore nurses’ experiences with infusion nursing practice to identify insights that could be used in interventions to promote safe medication administration.Patients and methods: This qualitative descriptive study used focus group interviews of 20 registered nurses who frequently administered medications in tertiary hospitals in South Korea. Data were collected through five semi-structured focus group interviews, with four nurses participating in each interview. We conducted inductive and deductive content analysis based on the 11 key topics of patient safety identified by the World Health Organization. Reporting followed the consolidated criteria for reporting qualitative research (COREQ) checklist.Results: Participants administered infusions in emergency rooms, general wards, and intensive care units, including patients ranging from children to older adults. Two central themes were revealed: human factors and systems. Human factors consisted of two sub-themes including individuals and team players, while systems encompassed three sub-themes including institutional policy, culture, and equipment.Conclusion: This study found that nurses experienced high levels of stress when administering infusions in the correct dose and rate for patient safety. Administering and monitoring infusions were complicated because nursing processes interplay with human and system factors. Future research is needed to develop nursing interventions that include human and system factors to promote patient safety by reducing infusion-related errors.Keywords: intravenous infusions, medication errors, medication systems, nurses, patient safety

Objective: To systematically review the evidence for intrathecal or intraventricular plus intravenous administration of antibiotics compared with standard management for postsurgical meningitis or ventriculitis. Methods: The following databases were searched: MEDLINE, the Central Register of Controlled Trials (CENTRAL); PubMed, EMBASE; and reference list of articles. Results: Administration of intrathecal/intraventricular antibiotics was associated with decreased mortality (OR 0.27 [95% CI 0.15–0.49] p = < 0.00001), increased cure rate (OR 3.4 [95% CI 1.6–7.22] p = 0.001). There was no difference in the occurrence of reinfection rate, and in poor functional outcome (OR 0.57 [95% CI 0.21–1.60] p = 1.6 p = 0.29; OR 0.43 [95% CI 0.11–1.68] p = 0.22). Conclusions: Intrathecal/intraventricular plus intravenous administration of antibiotics improves survival and cure rate in patients with postoperative meningitis or ventriculitis. More high-quality studies are needed. [ABSTRACT FROM AUTHOR]

The use of central venous access devices is ubiquitous in both inpatient and outpatient settings, whether for critical care, oncology, hemodialysis, parenteral nutrition, or diagnostic purposes. Radiology has a well-established role in the placement of these devices due to demonstrated benefits of radiologic placement in multiple clinical settings. A wide variety of devices are available for central venous access and optimal device selection is a common clinical challenge. Central venous access devices may be nontunneled, tunneled, or implantable. They may be centrally or peripherally inserted by way of veins in the neck, extremities, or elsewhere. Each device and access site presents specific risks that should be considered in each clinical scenario to minimize the risk of harm. The risk of infection and mechanical injury should be minimized in all patients. In hemodialysis patients, preservation of future access is an additional important consideration. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation. [ABSTRACT FROM AUTHOR]

Aim: To systematically evaluate the efficacy of different topical treatments for PVC‐related phlebitis in hospital in‐patients. Design: A systematic review and meta‐analysis. Methods: A selection was made of experimental and quasi‐experimental studies published in English or Spanish. These should provide data on the degree of phlebitis, pain and infiltration (means and standard deviations, mainly) of hospitalized patients with phlebitis secondary to peripheral venous catheter. All those studies that reflected systemic or exclusive prevention treatments were excluded. Searches were from inception to April 2020. The date of data collection was from December 2020 to May 2021. The selection criteria were based on the PICOS model. Risk of bias was assessed using the Cochrane Collaboration tool. Results: Twelve studies (726 patients) met the inclusion criteria. With respect to the decrease in the degree of phlebitis, was found ichthammol glycerine, followed by heparinoids. As for degree of pain, sesame oil obtained the most marked reduction. In terms of degree of infiltration, heparinoids and ichthammol glycerine were the only products to achieve a statistically significant reduction. The most important limitations are the low quantity and quality of the trials included. Insufficient data are available to draw valid conclusions about the efficacy of any treatment. [ABSTRACT FROM AUTHOR]

Introduction: The objective of this study was to compare the continuous infusion of cefepime with the intermittent infusion in patients with sepsis caused by Gram-negative bacilli (GNB). Methods: Randomized 1:1 multicenter double-blinded placebo-controlled study with allocation concealment; multicenter study in the intensive care units of Colombia. Patients with sepsis, severe sepsis or septic shock, and GNB-suspected bacteremia. Cefepime was administered for 7 to 14 days over 30 m intermittently every 8 h over 24 h plus continuous saline solution (0.9%) (G1) or 3 g administered continuously plus saline solution every 8 h (0.9%) (G2). The percentage of clinical response at 3, 7, and 14 days, relapse at 28 days, and mortality at discharge were measured. Results: The recruitment was stopped at the suggestion of the Institutional Review Board (IRB) following an FDA alert about cefepime. Thirty-two patients were randomized; 25 received the intervention, and GNB bacteremia was confirmed in 16 (9 G1 and 7 G2). Favorable clinical response in days 3, 7, and 14 was 88.8%, 88.8%, and 77.8% (G1) and was similar for G2 (85.7%). There were no relapses or deaths in G2, while in G1, one relapse and two deaths were observed. Conclusions: The results of this study support the use of cefepime for the treatment of Gram-negative infections in critically ill patients, but we could not demonstrate differences between continuous or intermittent administration because of the small sample size, given the early suspension of the study.

Abstract Aim To understand the experience of critical care nurses when performing common, yet error‐prone, programming tasks on two unfamiliar intravenous smart pumps. Design A qualitative descriptive study using data collected during a previous quantitative pilot study. Methods Following completion of common intravenous programming tasks each participant was interviewed using a semi‐structured interview guide. All interview data were coded line‐by‐line and thematic analysis revealed themes across all participants' interviews. Results The following four themes were identified: appreciation for attractive design features, the need for efficiency, the importance of intuitive use and concern for patient outcomes. Overall, these themes provide evidence that nurses strongly prefer a more usable intravenous smart pump interface that integrates safeguards to efficiently improve patient outcomes. Findings support the need for intravenous smart pump technology to be developed with an intuitive interface that decreases the level of cognitive demand and will lead to improved patient safety.

Introduction: Pediatric oncology patients have a limited number of venous access routes and need a large number of drugs during hospitalization. This study evaluates potential MI in pediatric oncology prescriptions and identifies possible factors associated with the risk of their occurrence. Methods: Cross-sectional study that evaluated prescriptions from a universitary and tertiary hospital from december 2014 to december 2015. The association between the variables and the risk to potential incompatibilities between drugs was determined by Student’s t test and Pearson’s chi-square, considering p

Purpose Medication errors are a significant and preventable source of patient harm, especially in the neonatal population. Standardized infusion concentrations increase patient safety and streamline the workflow for pharmacists, nurses, and physicians. Methods Neonatal continuous infusion concentrations were standardized and implemented into the electronic health record using an automated order panel. Pre- and postimplementation data were collected to assess the impact of this quality improvement initiative. The primary endpoint was the proportion of neonatal intensive care unit infusion orders that were compatible with "bolus from infusion" functionality in the syringe pump. Results Before implementation, only 40% of eligible infusions were compatible with the "bolus from infusion" function, compared to 93% after implementation (P < 0.00001). Within the syringe pump, the ratio of total options to the number of concentrations per medication was reduced by 31%. Conclusion Implementation of an order panel with defaulted standard infusion concentration selection improved workflow and optimized technology in the neonatal intensive care unit. [ABSTRACT FROM AUTHOR]

Copyright of Revista de Pesquisa: Cuidado é Fundamental is the property of Revista de Pesquisa: Cuidado e Fundamental Online and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives: Liposomal amphotericin B is a broad-spectrum antifungal treatment used for lifethreatening infections, but it commonly induces infusion-related adverse events that may prevent treatment completion. Based on anecdotal evidence, a slow infusion guideline at treatment initiation has been suggested to reduce these reactions. This study aimed to determine if slowing down the infusion rate on treatment initiation would reduce the rate of infusion-related adverse events. Methods: A retrospective cohort study was conducted examining the primary outcome of adverse event rates between patients who received slow and standard (2-hour or faster) infusions at a major hospital in Australia. Secondary outcomes were risk factors associated with infusion reactions. The rates of adverse events were analyzed using Fisher's exact test. Results: An 8-year audit identified 47 patients who were administered liposomal amphotericin-B. The average age of the study population was 61.7 years and 28 (59.6%) were male patients. Slower than standard infusions were given to 5 (10.6%) patients on treatment initiation. Infusion-related adverse events occurred in 2 (40.0%) patients with reduced rates and 5 (11.9%) patients with standard infusion rates (p=0.154). Typical reactions were myalgia, dyspnoea, and flushing. Four patients with adverse events had been rechallenged after further rate reductions and prophylactic medications with the completion of treatment. No risk factors for adverse events were identified among demographics, comorbidities, or co-prescribed medications. Conclusion: Slowing the infusion rate of liposomal amphotericin-B administration does not appear to reduce the likelihood of infusion-related reactions, however, it can be trialed for adverse-event management. J Microbiol Infect Dis 2022; 12(4): 148-153. [ABSTRACT FROM AUTHOR]

Copyright of Nefrologia is the property of Revista Nefrologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Pediatric oncology patients have a limited number of venous access routes and need a large number of drugs during hospitalization. This study evaluates potential medication incompatibilities (MI) in pediatric oncology prescriptions and identifies possible factors associated with the risk of their occurrence. Methods: This cross-sectional study evaluated prescriptions from a tertiary universitary hospital from December 2014 to December 2015. The association between variables and the risk of potential incompatibilities between drugs was determined by Student's t-test and Pearson's chi-square, considering p < 0.05 significant. The odds ratio was calculated considering a 95% confidence interval for each drug. Results: 385 prescriptions were evaluated. The mean age of 124 patients was 9.22 years old (SD = ± 5.10), and 50.65% were male. The most frequent diagnosis and reason for hospitalization were leukemia (27.30%) and chemotherapy (36.10%). The totally implantable catheter was the most commonly used venous access (61.30%). In 87.5% of prescriptions, there was the possibility of MI, and 2108 incompatibilities were found, considering 300 different combinations between two drugs. Age, diagnosis, reason for hospitalization, and type of venous access were risk factors for potential incompatibilities (p < 0.05). The following drugs present higher risk of potential incompatibilities: leucovorin, sodium bicarbonate, cefepime, diphenhydramine, dimenhydrinate, hydrocortisone, and ondansetron, with a significant odds ratio. Conclusion: The possibility of MI in prescriptions for pediatric oncology patients is frequent. Thus, the identification of risk factors may contribute to patient safety and to the rational use of drugs. [ABSTRACT FROM AUTHOR]

Background: The antecubital fossa is an important site for venepuncture and intravenous procedures. The size and location of a vein can affect the success of venepuncture and intravenous access. Several studies have investigated the superficial vein morphometry, but they had small sample sizes or focused on specific populations or groups. Therefore, we conducted a prospective study with large participants in general population to analyse the morphology of the antecubital superficial vein and identify the association of sex, age and body mass index (BMI) with the size and location of the vein., Methods: This study collected images of superficial veins prospectively using autonomous robotic ultrasound on the antecubital area between October and November 2020. We measured the superficial vein depth, vertical diameter and horizontal diameter at the antecubital area, extracted population characteristics (sex, age and BMI), and analysed a relationship between the vein dimensions and the characteristics., Results: In this study, data from 461 participants (201 males and 260 females) with mean age of 41.1 years were produced. The mean vein depth, mean vertical diameter and mean horizontal diameter (±standard deviation) were 4.81 (±2.17), 3.01 (±1.10) and 4.46 (±1.60) mm, respectively. We found significant differences in vein dimensions between males and females, with males having larger vertical and horizontal diameters than females ( p  < 0.001). The study also revealed significant differences in vein depth and dimensions among age groups and BMI subgroups ( p  < 0.001)., Conclusions: These findings revealed that the superficial vein in the antecubital area was oval, with a larger horizontal diameter than vertical diameter. Morphometry revealed differences in sex, age and BMI. Understanding variations in vein dimensions among different subgroups can help medical professionals improve success rate of venous access and patient safety., Competing Interests: Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Seoyeon Park, Yunmyeong Kim and Deokgeun Nam are employees of AIRS Medical. The other authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Aims and Objectives: Evaluate the effect of IV line labels on nurses' identification of high-alert medications in a simulated scenario of multiple infusions for critically ill patients., Design: Randomised crossover simulation experimental study., Methods: A study was conducted on 29 nurses working in intensive care for over 6 months. They were given two critical scenarios in a simulated environment, one with labels and the other without labels, involving multiple intravenous infusions. The nurses had to identify the medications infused into the critical patients' intravenous lines and disconnect a specific line. The data were collected and analysed to evaluate the errors made by the nurses in identifying and disconnecting the medications and the time they spent carrying out the tasks. The Wilcoxon test was used to analyse the variation in outcome before and after the intervention., Results: Approximately one-third of the study participants incorrectly identified the intravenous lines in both scenarios. There was no significant difference in the average number of errors between the scenarios with and without labels. However, the time taken to perform the tasks in the scenario with labels was 1 min less than in the scenario without labels, suggesting a potential efficiency gain., Conclusions: The labels on the intravenous lines allowed for quick drug identification and disconnection. The professionals performed similarly in correctly recognising the high-alert medication intravenous lines, in the scenarios with or without labels., Relevance to Clinical Practice: The label can be used as a technology to prevent misidentification of high-alert medications administered to critically ill patients through intravenous lines, thereby enhancing medication safety in healthcare institutions. No Public Contribution., (© 2024 John Wiley & Sons Ltd.)

In this study, we assessed the possibility of using portable laser Doppler flowmeters for determining the state of the blood microcirculatory system in upper and lower limbs of diabetic patients during the treatment course with intravenous α-lipoic acid infusions. A series of experimental studies were conducted in a cohort of ten inpatients with a confirmed diagnosis of type 2 diabetes mellitus. The state of peripheral blood flow of patients was assessed during 5 days on which they received daily doses of intravenous α-lipoic acid infusions. The values of the microcirculation and nutritive blood flow indices, as well as the bypass index, were assessed. To obtain a more extensive analysis, the patients' measurement results were compared with those of the control group composed of ten conditionally healthy volunteers of similar age. To determine changes in the regulatory mechanisms for the microcirculatory bed, we applied the amplitude-spectrum analysis of microvascular blood flow oscillations, using the mathematical tool of wavelet transform. We determined the changes in the index of blood microcirculation and the parameters of microcirculatory blood flow distribution into nutritive and shunt pathways, as well as the differences between these changes in upper and lower limbs. This approach is believed to become prospective as a pharmacotherapy efficacy assessment method based on responses of the system of blood microcirculation. [ABSTRACT FROM AUTHOR]

Aim: To understand the experience of critical care nurses when performing common, yet error‐prone, programming tasks on two unfamiliar intravenous smart pumps. Design: A qualitative descriptive study using data collected during a previous quantitative pilot study. Methods: Following completion of common intravenous programming tasks each participant was interviewed using a semi‐structured interview guide. All interview data were coded line‐by‐line and thematic analysis revealed themes across all participants' interviews. Results: The following four themes were identified: appreciation for attractive design features, the need for efficiency, the importance of intuitive use and concern for patient outcomes. Overall, these themes provide evidence that nurses strongly prefer a more usable intravenous smart pump interface that integrates safeguards to efficiently improve patient outcomes. Findings support the need for intravenous smart pump technology to be developed with an intuitive interface that decreases the level of cognitive demand and will lead to improved patient safety. [ABSTRACT FROM AUTHOR]