Intravenous Administration Sets Research Articles

Reducing plastic waste in intensive care from longer use of intravenous administration and invasive monitoring sets: A before-and-after study

IntroductionIntensive care unit (ICU) treatment carries a large environmental burden. Extending routine replacement of plastic line sets that belong to intravenous administration or invasive monitoring might lower waste from single-use plastics in ICUs. We extended the routine replacement interval of line sets from 4 to 7 days and assessed plastic waste reduction. MethodsIn this single center retrospective study the extension of the time interval from 4 to 7 days for routine replacement of line sets and its effect on plastic waste was assessed. The intervention was done at the start of 2022. Secondary outcomes were catheter-related bloodstream infections (CRBSI), nursing workload, costs and material durability. ResultsIn total 1221 patients were admitted to ICU; 636 in the pre-intervention period and 585 in the post-intervention period. There was a reduction of 881 replacement sets, 182 kg of waste and 96 nursing hours in 2022. There was no difference in CRBSI incidence. ConclusionThis study demonstrates the benefits of 7-day replacement intervals for intravenous administration and invasive monitoring sets. We established this in terms of waste reduction, patient safety and costs.

Increasing Utilization of Scrubbing Devices for Peripheral Intravenous Disinfectable Needleless Closed Connectors.

Introduction Peripheral intravenous (IV) administration sets are a source of infection that increases morbidity, mortality, and healthcare costs. In this quality improvement project, we aimed to enhance compliance with peripheral IV hub disinfection at anesthesia induction to follow the American Society of Anesthesiologists (ASA) safe medication injection guidelines. Methods Thisstudy was conducted in the main operating suite of the University of Miami's principal hospital between June and October 2023. Audits of scrubbing device utilization by the anesthesiology team and focus groups were conducted before and after two educational interventions. Educational efforts focused on increasing compliance with peripheral IV disinfection using scrubbing devices. Results Mean use per case, inferred from the number of devices dispensed, nearly doubled from 0.44 (95% CI, 0.37 to 0.59) to 0.82 (95% CI, 0.77 to 0.88) (P < 0.0001). Implications regarding steps to further enhance compliance are discussed. Conclusions Through a simple educational program, scrubbing device utilization increased significantly from baseline.

Prolonged use of intravenous administration sets on central line associated bloodstream infection, nursing workload and material use: A before-after study

ObjectivesOne of the interventions to reduce risk of central line associated bloodstream infection (CLABSI) is routine replacement of the intravenous administration sets. Guidelines advises a time interval that ranges between four and seven days. However many hospitals replace intravenous administration sets every four days to prevent CLABSI. Research methodologyIn this single centre retrospective study we analysed whether the extension of the time interval from four to seven days for routine replacement of intravenous administration sets had impact on the incidence of CLABSI and colonization of the central venous catheter. Secondary outcomes were the effects on nursing workload, material use and costs. ResultsIn total, 1,409 patients with 1,679 central lines were included. During the pre-intervention period 2.8 CLABSI cases per 1,000 catheter days were found in comparison with 1.3 CLABSI cases per 1,000 catheter days during the post-intervention period. The rate difference between the groups was 1.52 CLABSI cases per 1,000 catheter days (95% CI: −0.50 to +4.13, p = 0.138). The intervention resulted in a saving of 345 intravenous single use plastic administration sets and 260 hours nursing time, and reduced cost with an estimate of at least 17.250 Euros. ConclusionExtension of the time interval from four to seven days for routine replacement of intravenous administration sets did not negatively affect the incidence of CLABSI. Implications for clinical practiceAdditional benefits of the prolonged time interval were saving of nursing time by avoiding unnecessary routine procedures, the reducing of waste because of reducing the use of disposable materials and healthcare costs.

Closed intravenous systems for central vascular access: A difference maker for CLABSI rates in neonates?

Infants in neonatal units are susceptible to numerous potential iatrogenic risks. One key concern is central line-associated blood stream infection (CLABSI). To ensure patient safety and reduce the incidence of CLABSI toward zero, numerous evidence-based clinical interventions and product innovations have been implemented. Nevertheless, sustaining zero CLABSI for sustained periods remains challenging. The purpose of this study was to evaluate the impact on CLABSI rates of introducing a preassembled closed intravenous (IV) administration set in a neonatal intensive care unit (NICU). This was a retrospective observational analysis of routinely collected anonymized IV therapy infection data in a NICU. The study period was from January 2019 through June 2020. Nine-hundred eighty five patients with a Epicutaneo-Caval Catheter (ECC) were included (456 legacy IV set, 529 closed IV set). Patient demographics were comparable between the two groups. ECC dwell time was the only IV characteristic associated (p = 0.04) with CLABSI. Mann-Whitney U-test demonstrated significant differences between the two sets for CLABSI complication events (p = 0.031). Prior to using the closed IV administration sets (January 2019-September 2019) the mean monthly CLABSI rate was 2.87 (/1000 device days). This figure declined to 0.22 (/1000 device days) afterwards (October 2019-June 2020). Zero CLABSIs were observed during January to June 2020. Utilization of a pre-assembled closed IV administration set was associated with a reduction in CLABSI rates. The study results suggest that using a pre-assembled closed IV set concurrently with evidence-based central line infection control interventions can help attain extended periods of zero CLABSI.

Role and Responsibility of Nurses in Central Line - Insertion and Maintenance

Introduction -A central venous catheter (CVC) is thin, a flexible tube (catheter) that is placed into a large vein above the Heart. It may be inserted through A vein in the Neck, (internal jugular) chest (subclavian vein. Axillary vein) groin (femoral vein), or through veins in the arms known as a PICC, or peripherally inserted central catheters. Site- Internal jugular vein, subclavian vein, axillary vein, femoral veins, the best approach or access point for Central line insertion. Indications - The indications for central venous access are broad and are often situational. Inability to obtain venous access in emergent situations, chemotherapy administration, medications administration (Vasopressors. inotropic administration Total Parental nutrition administration, Hemodynamic monitoring are common indications for CVC insertion. Contraindication- Local cellulitis, Low platelet count, Local infections, Thrombocytopenia, Congenital anomalies, Trauma are common contraindications of CVC insertion. Complications - Numerous potential complications can occur during the procedural placement of a central venous catheter, but also as a result of the indwelling equipment. Arrhythmias, Arterial puncture, Pulmonary puncture with or without resultant pneumothorax, Bleeding – hematoma formation, which can obstruct the airway, Tracheal injury, Air emboli during venous puncture or removal of the catheter, Pulmonary embolism, Local cellulitis, Catheter infection, Cardiac tamponade, Intravascular loss of guidewire, Hamo thorax, Phrenic nerve injury, Brachial plexus injury, Cerebral infarct from carotid artery cannulation, Bladder perforation, Bowel perforation, Sterile Thrombophlebitis. Post-procedural complications: Catheter-related bloodstream infections – bacterial or fungal, Central vein stenosis, Thrombosis, Delayed bleeding with multiple attempts in a coagulopathic patient Clinical Significance - Ensure that sterile products are not contaminated and that there is no evidence of damage to the packaging. Follow sterile procedures at all times. Central line infections can be a serious and life-threatening illness. Always ensure that the catheter is appropriately placed through one or several methods: radiographic evidence, measurement of CVP, or by analyzing a venous blood gas. Never use excessive force during any part of this procedure. It will lead to damage to local structures. Nursing Responsibility - After a CVC placement, nurses are responsible for maintaining, monitoring, and utilizing central venous catheters. The assigned nurse must check complications such as infections, hematoma, thrombosis of the catheter, and signs of pneumothorax and bleeding. Nurses are also responsible for ensuring that the site is maintained in a clean and sterile fashion. Daily inspection of the access site and device patency should be performed during nursing rounds. In particular, nursing officers must disinfect injection ports, catheter hubs, and needleless connectors with institutionally approved antiseptics. Intravenous administration sets should be changed regularly per hospital policy. The site should be checked for bleeding, hematoma formation, and signs of cellulitis, which include erythema, purulent drainage, and/or warmth. Dressings should be changed if visibly soiled. This must be performed with proper sterile technique. Keywords: CVC, Central Line, Central venous catheter.

Nurses' decision‐making about intravenous administration set replacement: A qualitative study

To explore nurses' decision-making regarding intravenous administration set replacement for vascular access device infusions in paediatric and adult clinical settings. Intravenous administration sets are routinely replaced at regular intervals in clinical practice with the goal of preventing catheter-related bloodstream infection; however, emerging evidence is challenging traditional hang-time durations. Nurses' perceptions and contextual factors affecting decision-making for administration set replacement have not been assessed previously. Qualitative study using focus groups with contextualism methodology and inductive analysis. During November-December 2016, eight semi-structured focus groups were conducted with 38 nurses at two metropolitan hospitals in Queensland, Australia. Interviews were audio-recorded and transcribed. Two authors independently reviewed transcripts and extracted significant statements using Braun and Clarke's 7-step method of thematic analysis. The COREQ checklist provided a framework to report the study methods, context, findings, analysis and interpretation. Five key themes emerged from the analysis: (a) infection prevention, (b) physical safety, (c) patient preference, (d) clinical knowledge and beliefs, and (e) workload. Administration set replacement can be a complex task, particularly when patients have multiple infusions and incompatible medications. Nurses drew on perceptions of patient preference, as well as previous experience, knowledge of peer experts and local policies, to aid their decisions. Nurses use clinical reasoning to balance patient safety and preferences with competing workplace demands when undertaking administration set replacement. Nurses rely on previous experience, hospital and medication manufacturer policies, and peer experts to guide their practice. Nurses at times deviate from clinical guidelines in the interests of patient acuity, nurses' experience and workload. The findings of this study indicate nurses also balance considerations of patient preference and safety with these competing demands.

Adsorption and Leachable Contamination of Flucloxacillin, Cyclosporin and Amiodarone Following Delivery Through an Intravenous Administration Set.

Interactions between a pharmaceutical drug and its delivery device can result in changes in drug concentration and leachable contamination. Flucloxacillin, amiodarone and cyclosporin were investigated for drug concentration changes and leachable contamination after delivery through an intravenous administration set. Flucloxacillin, amiodarone and cyclosporin were delivered through an intravenous administration set and the eluate analysed by HPLC-UV and HPLC-MS. The average recovery of flucloxacillin was 99.7% and no leachable compounds were identified. The average recovery of cyclosporin was 96.1%, which contrasts previous findings that have reported up to 50% loss of cyclosporin. This is likely due to the use of DEHP-free administration sets in this study, as adsorption of cyclosporin is linearly related to DEHP content. The average recovery of amiodarone was 91.5%. 5-hydroxymethylfurfural was identified in the amiodarone solution following delivery through the administration set as well as the 5% glucose solution used for delivery. Drug/administration set interactions may modify pharmaceuticals during delivery. In this study, only 90% of the amiodarone was delivered through a generic administration set. Given the growing use of generic administration sets in hospital settings, validation of the suitability of their use is required to ensure patient safety and expected levels of efficacy.

Intravenous administration set (infusion tubing) replacement after 4 or 7 days is equally effective to prevent bloodstream infections (RSVP trial)

Sponsored by the Australian and New Zealand Intensive Care Society

A comparison of the pharmacokinetic and pharmacodynamic properties of nitroglycerin according to the composition of the administration set: A preliminary study.

Background:There is a risk of drug sorption into an intravenous administration set composed of polyvinyl chloride (PVC), polyurethane (PU), or polyolefin (PO). This has implications on the dose of the active ingredient the patient receives, and thus therapeutic success. This study aimed to determine the plasma concentration of nitroglycerin and the effect of nitroglycerin on patients based on the composition of the administration set.Methods:Using a randomized, open-labeled, 3 × 3 crossover method, 9 volunteers were assigned to 3 groups. In period I, nitroglycerin (100 μg/mL) was infused via a PVC- (group A), PU- (group B), or PO-based (group C) administration set. In period II, PU- (group A), PO- (group B), and PVC-based (group C) administration sets were used, and in period III, PO- (group A), PVC- (group B), and PU-based (group C) administration sets were used. The rate of drug administration in all periods was 12 mL/hour for 30 minutes using an infusion pump. Blood samples were collected, and the plasma concentrations of nitroglycerin were analyzed using validated high-performance liquid chromatography coupled with tandem mass spectrometry. Blood pressure was determined using a sphygmomanometer applied to the other upper arm at an interval of 5 minutes.Results:We observed that the mean plasma concentration of nitroglycerin over time when administered using a PO-based tube was higher than that when using a PU- or PVC-based tube. When the percent change of the mean arterial pressure from baseline at each time point was compared among groups, there were statistically significant differences between PU and PO or PVC at most points during nitroglycerin infusion.Conclusion:Our results showed higher nitroglycerin plasma concentration and lower arterial pressure when a PO-based administration set was used than when a PVC- or PU-based administration set was used. PO-based administration sets may be more appropriate for nitroglycerin administration compared to those composed of PVC or PU.

Effect of Delaying Replacement of Parenteral Nutrition Intravenous Administration Sets: Preclinical Experiments and a Dynamic Laboratory Model of Microbial Colonization

Recommendations prescribe daily intravenous administration set (IVAS) replacement for parenteral nutrition (PN) comprising intravenous fat emulsions (IVFE) due to risk of micro-organism growth and resultant central-line associated bloodstream infections (CLABSIs), but system disconnection for this practice may allow contamination and CLABSIs. Laboratory experiments and model development were used to simulate PN administration after contamination from healthcare workers' hands. This study observed the growth of micro-organisms known to cause CLABSIs in a variety of PN and other IV fluids and developed a model to investigate the effect of delaying IVAS replacement on microbial growth for up to 7 days. Micro-organisms grew at different rates and were affected by solution type. In static experiments, growth was supported in IVFE and all-in-one PN, but suppressed in 50% glucose. Growth patterns were consistent over time for Staphylococcus epidermidis, Staphylococcus aureus, and Candida albicans in IVFE, all-in-one PN, and 0.9% sodium chloride in both static and dynamic experiments. C. albicans grew exponentially to clinically significant numbers in all-in-one PN and IVFE IVAS after 30 hours, but negligible growth of S. epidermidis or S. aureus occurred for 7 days. All-in-one PN and IVFE support the C. albicans growth after minimal initial contamination, with micro-organisms migrating from the fluid bag to the central venous access device. Improved aseptic nontouch technique during clinical practice is vital to prevent contamination. Daily IVAS replacement of for all-in-one PN and IVFE should continue until the safety of prolonging IVAS replacement is confirmed by randomized trials.

Protein Adsorption to In-Line Filters of Intravenous Administration Sets

Ensuring compatibility of administered therapeutic proteins with intravenous administration sets is an important regulatory requirement. A low-dose recovery during administration of low protein concentrations is among the commonly observed incompatibilities, and it is mainly due to adsorption to in-line filters. To better understand this phenomenon, we studied the adsorption of 4 different therapeutic proteins (2 IgG1s, 1 IgG4, and 1 Fc fusion protein) diluted to 0.01 mg/mL in 5% glucose (B. Braun EcoFlac; B. Braun Melsungen AG, Melsungen, Germany) or 0.9% sodium chloride (NaCl; Freeflex; Fresenius Kabi, Friedberg, Germany) solutions to 8 in-line filters (5 positively charged and 3 neutral filters made of different polymers and by different suppliers). The results show certain patterns of protein adsorption, which depend to a large extent on the dilution solution and filter material, and to a much lower extent on the proteins' biophysical properties. Investigation of the filter membranes' zeta potential showed a correlation between the observed adsorption pattern in 5% glucose solution and the filter's surface charge, with higher protein adsorption for the strongly negatively charged membranes. In 0.9% NaCl solution, the surface charges are masked, leading to different adsorption patterns. These results contribute to the general understanding of the protein adsorption to IV infusion filters and allow the design of more efficient compatibility studies.

Criteria for choosing an intravenous infusion line intended for multidrug infusion in anaesthesia and intensive care units

ObjectiveThe aims are to identify critical parameters influencing the drug mass flow rate of infusion delivery to patients during multidrug infusion and to discuss their clinical relevance. Data sourcesA review of literature was conducted in January 2016 using Medline, Google Scholar, ScienceDirect, Web of Science and Scopus online databases. Data extractionReferences relating to the accuracy of fluid delivery via gravity-flow intravenous (IV) infusion systems and positive displacement pumps, components of IV administration sets, causes of flow rate variability, potential complications due to flow rate variability, IV therapies especially at low flow rates and drug compatibilities were considered relevant. Data synthesisSeveral parameters impact the delivery of drugs and fluids by IV infusion. Among them are the components of infusion systems that particularly influence the flow rate of medications and fluids being delivered. By their conception, they may generate significant start-up delays and flow rate variability. Performing multidrug infusion requires taking into account two main points: the common dead volume of drugs delivered simultaneously with potential consequences on the accuracy and amount of drug delivery and the prevention of drug incompatibilities and their clinical effects. ConclusionTo prevent the potentially serious effects of flow rate variability on patients, clinicians should receive instruction on the fluid dynamics of an IV administration set and so be able to take steps to minimise flow rate changes during IV therapy.

Investigating the impact of clinical anaesthetic practice on bacterial contamination of intravenous fluids and drugs

Syringes (N = 426), ventilator machine swabs (N = 202) and intravenous (IV) fluid administration sets (N = 47) from 101 surgical cases were evaluated for bacterial contamination. Cultures from the external surface of syringe tips and syringe contents were positive in 46% and 15% of cases, respectively. The same bacterial species was cultured from both ventilator and syringe in 13% of cases, and was also detected in the IV fluid administration set in two cases. A significant association was found between emergency cases and contaminated syringes (odds ratio 4.5, 95% confidence interval 1.37-14.8; P = 0.01). Other risk factors included not using gloves and failure to cap syringes.

Acute exacerbation of cold agglutinin disease during operation

Cold agglutinin, an autoantibody that combines with the red blood cell (RBC) carbohydrate antigen, is known to trigger hemolysis with agglutination at temperatures of 0-4℃ [1]. Cold agglutinin combined with RBC in a peripheral body exposed to a cold environment returns to the center of the body and combines with the complement; these processes form the mechanism for chronic cold agglutinin disease. However, these processes can result in acute aggravation due to stimuli such as infection and trauma [2]. The authors experienced hemolysis during an operation in a patient with cold agglutinin disease although his temperature was maintained above 35.6℃. A 67-year-old male patient diagnosed with bladder cancer was scheduled for a radical cystectomy with ileal conduit formation. He had been diagnosed with idiopathic cold agglutinin disease 20 years earlier. Hematologic conditions were stable without any medication. Hemoglobin was measured as 6.9 g/dl 2 days prior to the surgery. After 3 units of leukocyte-depleted RBC were transfused, the hemoglobin level increased to 9.9 g/dl. The cold agglutinin titer was 1 : 8192 and total bilirubin was 2.9 g/dl before the surgery. On the day of the surgery, the temperature of the operation room was raised to its maximum of 30℃. An esophageal stethoscope with a temperature probe was inserted after induction to read the core body temperature (BT), and a skin temperature probe was attached to the forehead to read the peripheral BT. The body of the patient, excluding the site of surgery, was covered in cotton blankets, and 2 air warmers were used. A normothermic (37℃) intravenous fluid administration set was used to elevate the temperature of all fluids. The inhalational gas supplied to the patient was set at 37℃ using a heated circuit. The core BT of the patient was 37℃ and his peripheral BT was 35.6℃ during the surgery. It was observed that the urine had a strong brown color [3], and at 60 minutes after anesthesia (30 minutes after the operation), blood tests showed hemoglobin at 11.0 g/dl, lactate dehydrogenase (LDH) at 494 IU/L, total bilirubin at 5.4 g/dl, and direct bilirubin at 2.1 g/dl. We decided that postoperative plasmapheresis was more appropriate than intraoperative plasmapheresis [4]. The estimated blood loss during the 600 minute surgery was 2800 ml, infused fluid HES 500 ml, and normal saline 4800 ml. Leukocyte-depleted RBC 6-units were transfused. Therapeutic plasmapheresis was executed for 180 minutes in the intensive care unit. The patient's blood was extracted through an arterial line and reinfused through a central venous line. Both lines were passed through fluid warmers. Therapeutic plasmapheresis was completed without any complications. The test results were as shown in Table 1. The hemoglobin level was stable without any significant decrease; therefore, the patient was transferred to the general ward on postoperative day 5 (POD#5). During the intensive care unit (ICU) stay, the temperature taken from the arm pit was above 38℃ for the first 2 days and remained at 37-38℃ until the fifth day. After transfer to the general ward, RBC 1 unit was transfused on each of the following days: POD#8, POD#10, POD#13, and POD#15. The temperature taken from the arm pit remained at 38℃. The patient was discharged on POD#16 with a hemoglobin level of 8.9 g/dl, and a month after the surgery (2 weeks after discharge), the hemoglobin measured at ambulatory care was 7.4 g/dl. There were no complications afterwards. Table 1 Changes in Laboratory Findings In this case, although the cold agglutinin antibody number was relatively high at 1 : 8148, the reactivity was not high due to the BT being at 36℃. The decrease in temperature during the surgery, however, might have caused the hemolytic reaction. It can be assumed that the low temperature (around 20-25℃) decreased the BT and consequently increased cold agglutinin reactivity. The high activity of cold agglutinin induced the hemolysis, the urine color change, and the high bilirubin level. Ulvestad et al. [5] reported that hemolysis occurred after infection and trauma in a patient with chronic cold agglutinin disease. The increases in pro-inflammatory cytokines IL-1α, IL-6, TNF-α, and IFN-γ in response to trauma can cause both an increase in BT and complement-mediated hemolysis, as well as possibly trigger an exacerbation of hemolysis. The patient in this case experienced hemolysis even when a relatively high BT (above 35℃) was maintained during the surgery. In summary, the maintenance of BT has been regarded as the most important step in the anesthetic management of cold agglutinin disease patients. However, because exposure to a relatively low temperature (25℃) could modify the cold agglutinin, hemolysis may occur even when the core BT is maintained at around 35.6℃. During surgery, the urine color must be carefully observed, and hemoglobin, direct bilirubin, and LDH must be measured to monitor for hemolysis.

Does decreasing the frequency of changing intravenous administration sets (&gt;24 h) increase the incidence of sepsis in neonates receiving total parenteral nutrition?

The optimal timing for changing intravenous (IV) administration sets that contain total parenteral nutrition (TPN), with and without lipids, in neonates remains unknown. To determine whether decreasing the frequency of changing IV administration sets (>24 h versus every 24 h) in neonates increases the incidence of sepsis within seven days of discontinuation of TPN and microbial contamination of the infusate. The databases searched to identify studies that evaluated the frequency of IV administration sets on sepsis and microbial contamination of the infusate included MEDLINE, EMBASE, CINAHL, Cochrane Library, Scopus and Web of Science. The Evidence Evaluation Worksheet adapted from the American Heart Association's International Liaison Committee on Resuscitation was used to evaluate eligible studies for quality, level of evidence and direction of support. Two studies were reviewed; however, neither of the studies reported on the outcome of sepsis. One study reported that changing IV administration sets every 48 h did not increase the rate of infusate (amino acid or lipid) contamination compared with change every 24 h, while the other study reported an increase in the lipid infusate contamination rate when IV administration sets were changed every 72 h. There is insufficient evidence to support or refute routinely changing IV administration sets every 48 h or that decreasing the frequency of set changes increases the incidence of sepsis.

A literature review on flow‐rate variability in neonatal IV therapy

To provide an overview of factors influencing the flow rate in intravenous (IV) therapy for newborns. We conducted a review of the literature from 1980 to 2011 in PubMed and Web of Knowledge. Articles focusing on flow-rate variability and possible complications due to flow-rate variability were included. Forty-one articles were selected for this review. IV therapy in (preterm) neonates is prone to significant start-up delays and flow-rate variability. The sudden changes in the volume delivered to (preterm) neonates may have serious consequences. Low preprogrammed flow rates, total compliance, and volume of the IV administration set, the presence or absence of antisiphon valves or inline filters and the vertical displacement of syringe pumps all contribute to flow-rate variability in IV therapy for neonates. Flow-rate variability in IV therapy and its clinical relevance are due to the preprogrammed flow rate, the hydrostatic pressure changes, the complete IV administration set compliance and the type of substances supplied to the patient. To improve IV therapy, the internal compliance of the complete IV administration set should be minimized and the highest possible preprogrammed flow rate should be used in combination with small syringes and low-resistance valves.

Three Insulation Methods to Minimize Intravenous Fluid Administration Set Heat Loss

Objective. To assess the effect of three methods for insulating an intravenous (IV) fluid administration set on the temperature of warmed fluid delivered rapidly in a cold environment. Methods. The three chosen techniques for insulation of the IV fluid administration set involved enclosing the tubing of the set in 1) a cotton conforming bandage, 2) a reflective emergency blanket, and 3) a combination of technique 2 followed by technique 1. Intravenous fluid warmed to 44°C was infused through a 20-drop/mL 180-cm-long fluid administration set in a controlled environmental temperature of 5°C. Temperatures in the IV fluid bag, the distal end of the fluid administration set, and the environment were continuously measured with resistance thermosensors. Twenty repetitions were performed in four conditions, namely, a control condition (with no insulation) and the three different insulation methods described above. One-way analysis of variance was used to assess the mean difference in temperature between the IV fluid bag and the distal fluid administration set under the four conditions. Results. In the control condition, a mean of 5.28°C was lost between the IV fluid bag and the distal end of the fluid administration set. There was a significant difference found between the four conditions (p < 0.001). A mean of 3.53°C was lost between the IV fluid bag and the distal end of the fluid administration set for both the bandage and reflective emergency blanket, and a mean of 3.06°C was lost when the two methods were combined. Conclusion. Using inexpensive and readily available materials to insulate a fluid administration set can result in a reduction of heat loss in rapidly infused, warmed IV fluid in a cold environment.

Anaesthetic drug administration as a potential contributor to healthcare-associated infections: a prospective simulation-based evaluation of aseptic techniques in the administration of anaesthetic drugs

ObjectiveTo evaluate the possibility that anaesthetists are administering potentially pathogenic micro-organisms to their patients.DesignProspective microbiological and observational study in a realistic simulated setting.ParticipantsTen anaesthetists supported by 10 anaesthetic technicians.Primary outcome...

Stabilité et compatibilité du paracétamol, du kétoprofène et de l’amoxicilline administrés avec un perfuseur de sécurité

Objectives Intravenous infusion takes an important place in the current therapy in hospitals and pharmaceutical firms keep improving their infusion medical devices, particularly with the development of an intravenous administration set with an automatic infusion stop. The aim of our study consists in an evaluation of the stability of acetaminophen, ketoprofen and amoxicillin during infusion and stasis of drugs for several hours in the dropper chamber and in the tube of this device. Study design Analytical study. Materials and methods Ten milligram per millilitre acetaminophen (acetaminophen 1 and acetaminophen 2), 1 mg/mL ketoprofen and 20 mg/mL amoxicillin were prepared and infused individually and successively with the intravenous administration set under ambient light and temperature. Collected samples of each drug during the infusion and after 24 hours of stasis in the medical device were monitored by a visual inspection, pH and osmolality assessment and chromatographic analysis of each drug with a validated stability-indicating method. Results Repeated individual perfusions of 10 mg/mL acetaminophen 1 or 1 mg/mL ketoprofen are possible through a fail-safe intravenous administration set, while repeated individual amoxicillin infusions are not because of the unstability of this drug. There is also no problem to infuse successively acetaminophen and ketoprofen through this medical device because these drugs are stable. However, we underlined an incompatibility between acetaminophen 2 and ketoprofen, which advises against the use of intravenous administration set for successive infusions of these two drugs. Conclusion Despite the technical innovation of a fail-safe intravenous administration set, we have to stay aware of mixture consequences in intravenous infusion field.

Influence of Intravenous Administration Set Composition on the Sorption of Isosorbide Dinitrate

The influence of the composition of administration sets on the sorption of isosorbide dinitrate was investigated in-vitro. Isosorbide dinitrate solutions (250 micrograms mL-1) in 0.9% NaCl or 10% glucose were stored in glass containers and administered at a flow rate of 20 mL h-1. The influence of the concentration of different plasticizers (di-ethylhexylphthalate, tri-ethylhexyltrimelitate) in polyvinylchloride tubings was determined. Polybutadiene tubings of different mol. wt coextruded laminates of these polybutadienes with PVC of different composition and a polyethylene tubing were evaluated. The higher the Shore hardness of the PVC tubing, the lower the sorption. The infusion fluid played an additional role only for the tubings with high Shore hardness (greater than 70). The sorption of isosorbide dinitrate to polybutadiene tubings of different mol. wt was less than 2.5% after 5 h and was comparable with the sorption to the polyethylene tubing. When polybutadiene/PVC laminates were used, the sorption increased significantly and was in most cases dependent on the Shore hardness of the PVC (higher Shore hardness gave lower sorptions) and on the mol. wt of the polybutadiene (lower mol. wt resulted in higher sorption). Sorption was not dependent on the type of PVC plasticizer.