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Umbuzo: I-NorePinephrine ingumuthi wokutholakala phezulu ophathwe kahle (iv) njenge-invision eqhubekayo. Kungumsebenzi we-vasopresrer ovame ukubekelwa phansi ukuze alondoloze umfutho wegazi okwanele nokuqondisa i-argan fff in abagula kakhulu abadala nezingane ezine-hypotension enzima noma ukushaqeka okuphikelelayo naphezu kokuvunyelwa koketshezi okwanele. Ngisho namaphutha amancane ekutholeni noma ekutholeni umthamo, kanye nokubambezeleka ekwelashweni, kungaholela emiphumeleni emibi eyingozi. Uhlelo lwezempilo olunhlobonhlobo lusanda kuthunyelwa i-ISMP imiphumela yokuhlaziywa kwezizathu ezijwayelekile (i-CCA) ngamaphutha we-NorepinephPrine avela ngo-2020 no-2021. Ukuhlola izinhlangano eziningi nge-CCA Ivumela izinhlangano ezibuthakathaka. Idatha evela ohlelweni lokubika lwenhlangano kanye namaphampu we-smart invision asetshenziselwa ukukhomba amaphutha angaba khona.
I-ISMP ithole imibiko ehlobene ne-15 ehlobene noNoradrenaline ngo-2020 no-2021 ngohlelo lwe-ISMP National Medication Report Programme (ISMP PERP). Cishe ingxenye yesithathu yale mibiko yabhekana nezingozi ezihambisana namagama afanayo, amalebula, noma ukupakishwa, kepha akukho amaphutha abebikiwe. Sishicilele imibiko yamaphutha esiguli ayisikhombisa aseNoorePinephrine: amaphutha amane okudonswa kwamaphutha (Ephreli 16, 2020; Agasti 26, 2021; February 24, 2022); iphutha elilodwa lokuhlushwa okungalungile; iphutha elilodwa lokutholwa okungalungile kwesidakamizwa; ukuphazamiseka ngengozi kokufakwa kwe-norepinephrine. Yonke imibiko ye-16 ye-ISMP yengezwe ohlelweni lwezempilo lwe-CCA lwe-CCA (n = 106) nemiphumela efakwe echibini (n = 122) ngesinyathelo ngasinye kwinqubo yokusebenzisa izidakamizwa iboniswa ngezansi. Iphutha elibikiwe lifakiwe ukuhlinzeka ngesibonelo sezimbangela ezithile ezivamile.
Nikeza. Sikhombe izinto eziningana zokuqapha ezihambisana namaphutha anqunyelwe, kufaka phakathi ukusetshenziswa okungadingekile kwemiyalo yomlomo, ukucacisa i-Norepinephrine ngaphandle kokusetshenziswa kwamasethi omyalo, futhi kungaqondakali noma amapharamitha omyalo angasetshenziswa). Kwesinye isikhathi amapharamitha anqunyiwe anqunyelwe aqine kakhulu noma angenakwenzeka (isib Kwezinye izimo, odokotela bangase banikeze imithamo esekwe kakhulu noma engenzi isisindo, kepha lokhu kwesinye isikhathi kuyadideka. Lokhu kunqunywa kwebhokisi ebhokisini kukhulisa amathuba odokotela abaphansi enza amaphutha, kufaka phakathi amaphutha wokuhlela amaphampu, ngoba izinketho ezimbili ze-dosing zitholakala kumtapo wezincwadi wepampu. Ngaphezu kwalokho, ukubambezeleka kubikwa ukuthi kudinga ukucaciswa kwe-oda lapho ama-oda abekiwe afaka imiyalo esekelwe ekusekelweni.
Udokotela ucela umhlengikazi ukuthi abhale incwadi kadokotela i-norepinephrine yesiguli enomfutho wegazi ongazinzile. Umhlengikazi wangena kwi-oda njengoba udokotela o-oda ngomlomo Kepha imiyalo yemithamo yodokotela ixubile ukunwebeka okusekelwe kwesisindo ngesisindo ngesilinganiso esisezingeni eliphakeme kakhulu: ngesilinganiso ngesilinganiso se-5 mcg / min njalo ngemizuzu engu-5 / kg / min. I-Smart inhlangano ye-Smart Infusion ayikwazanga ukubopha umthonyo we-MCG / Min Osokhemisi kwadingeka babheke imiyalo nodokotela, okwaholela ekubambezeleni ekunakekeleni.
Lungiselela futhi usabalalise. Amaphutha amaningi okulungiselela nama-dosing kungenxa yomsebenzi wekhemisi opholile, okhuliswe ngabasebenzi bamakhemisi abadinga ukugxila okuphezulu kwe-NorePinephPrine infusions (32 mg / 250 ml) (etholakala kumakhemikhali we-503B kodwa angatholakali kuzo zonke izindawo). kuholele ekunikezeni okuningi nokukhathala. Ezinye izimbangela ezivamile zokuhambisa amaphutha afaka amaphutha eNoradrenaline zifihlwe ezikhwameni eziqinile okukhanyayo kanye nokuntuleka kokuqonda kwabasebenzi bamakhemisi abaphuthumayo bokuphuthumayo.
Ukufakwa ndawonye kwe-norepinephrine kanye ne-nicardipine esikhwameni esimnyama se-amber kungahambi kahle. Ukuze uthole infusion emnyama, uhlelo lwe-dosing luphrinte amalebula amabili, elinye esikhwameni sokumfaka ngokwalo nelinye ngaphandle kwesikhwama se-amber. I-NorePinephrine infusions ibekwe ngokungafanele emaphaketheni e-amber abhalwe ngokuthi "i-nicardipine" ngaphambi kokusatshalaliswa komkhiqizo ukuze isetshenziswe yiziguli ezahlukahlukene kanye okuphambene nalokho. Amaphutha awazange aqaphelekile ngaphambi kokusabalalisa noma ukuhambisa. Isiguli esiphathwe nge-nicardipine sanikezwa i-NorePinePnephrine kodwa asibanga ukulimala kwesikhathi eside.
Ezokuphatha. Amaphutha ajwayelekile afaka umthamo ongalungile noma iphutha lokuhlushwa, iphutha lesilinganiso esingalungile, nephutha elingalungile lezidakamizwa. Iningi lalawa maphutha kungenxa yohlelo olungalungile lwe-Smart infusion pump, ngokwengxenye ngenxa yokuba khona kokukhethwa kwethabo kulabhulali yezidakamizwa, ngesisindo nangaphandle kwawo; amaphutha wokugcina; Ukuxhuma nokuxhunyelelwa kabusha kokuphazamiseka noma okumisiwe kokufundela isiguli kwaqala ukumnika okungalungile noma akuzange kuphawule imigqa futhi akuzange kulandele khona uma kuqala ukumnika noma ukuqala ukumnika noma ukuqala ukumnika noma ukuqala ukumnika noma ukuqala ukumnika noma ukuqala ukumnika noma ukuqala ukumnika noma ukuqala ukumnika noma ukuqala ukumnika noma ukuqala ukumnika noma ukuqala kabusha. Kukhona okungahambanga kahle emakamelweni aphuthumayo kanye namakamelo okusebenza, kanye nokuvumelana kwe-Smart Pump namarekhodi ezempilo nge-elekthronikhi (EHR) akutholakalanga. I-ExtAvaSation eholela kumonakalo wezicubu nayo iye yabikwa.
Umhlengikazi ophethe i-NorePinePnephrine njengoba kuqondiswe ngesilinganiso se-0.1 μg / kg / min. Esikhundleni sokuhlela ipompo ukuletha u-0.1 MCG / kg / min, umhlengikazi uhlele ipompo ukuletha i-0.1 MCG / Min. Ngenxa yalokho, isiguli sathola amahlandla angama-80 aphansi we-NorePinePnephrine kunalokho obekiwe. Lapho ukumnika kancane kancane kwashiswa futhi kwafinyelela isilinganiso esingu-1.5 μg / min, umhlengikazi wahlulela ukuthi usefinyelele umkhawulo onqunyelwe we-1.5 μg / kg / min. Ngoba ingcindezi yesiguli evumayo yayisengejwayelekile, kwangezwa i-vasopresrescor yesibili.
Yokusungula nokugcina. Amaphutha amaningi avela lapho ugcwalisa amakhabethe we-othomathikhi (adcs) noma aguqule ama-sorepinephry vials kuma-corts anamakhodi. Isizathu esiyinhloko salawa maphutha wokusungula ukulebula okufanayo nokupakisha. Kodwa-ke, ezinye izimbangela ezivamile nazo zikhonjwe, njengamazinga ajwayelekile aphansi we-NorePinephPrine infusions e-ADC eyayinganele ukufeza izidingo zophiko lokunakekelwa kweziguli, okuholela ekubambeni kwezidingo zokwelashwa uma amakhemisi kufanele enze ama-infusions ngenxa yokushoda kwezidingo. Ukwehluleka ukuskena ibhakhodi yomkhiqizo ngamunye we-NorePinephrine ngenkathi ukugcina i-ADC kungenye into evamile yephutha.
Usokhemisi ugcwalise ngephutha i-ADC nge-Pharmacy-elungiselelwe ama-32 mg / 250 ml NorePinephnephrine Solution ku-4 mg / 250 ml Preprex Drawer. Umhlengikazi wahlangana nephutha ngenkathi uzama ukuthola ukumiswa kwe-4 mg / 250 ml NorePinePnephrine ku-ADC. Ibhakhodi ekufakweni komuntu ngamunye ayihlolwe ngaphambi kokuba ibekwe kwi-ADC. Lapho umhlengikazi eqaphela ukuthi kunesikhwama esingu-32/250 ml esikhwameni se-ADC (kufanele abe sengxenyeni efrijisiwe ye-ADC), wacela ukugxila okufanele. Izisombululo ze-NorePinephrine 4mg / 250ml infusion Solutions azitholakali emakhemisi ngenxa yokuntuleka komenzi wamaphakethe we-4mg / 250ml, okuholela ekubambezelweni ngosizo lokuxubha usizo.
Gada. Ukuqapha okungalungile kweziguli, okutholwa kwama-norepinephrine infusions ngaphandle kwamapharamitha oku-oda, futhi ungalindeli lapho kudingeka khona isikhwama esilandelayo se-infusion izimbangela zokuqapha amaphutha.
Isiguli esifayo esinama-oda ku- "asivusi kabusha" sifakwe nge-NorePinephPrine ukuze sigcine isikhathi eside ngokwanele ukuba umndeni wakhe ukusho okuhle. Ukufakwa kwe-NorePinephry kwaphela, futhi kwakungekho sikhwama esisele ku-ADC. Ngokushesha umhlengikazi wabiza ikhemisi futhi wafuna isikhwama esisha. Ikhemisi lalingenaso isikhathi sokulungiselela umuthi ngaphambi kokuba isiguli sidlule savuna umndeni wakhe.
Ingozi. Zonke izingozi ezingazange ziholele ephutheni kubikwa kwi-ISMP futhi kufaka phakathi ukubhala okufanayo noma amagama ezidakamizwa. Imibiko eminingi ikhombisa ukuthi ukufakwa kanye nokubhalela kokugxila okuhlukahlukene kwe-norepinephrine infusions ekhishwe ngabangu-503B abaphambili kubonakala sengathi kufana nokufana.
Izincomo zokwenza okuphephile. Cabanga ngezincomo ezilandelayo lapho uthuthuka noma uvuselela isu lakho lesikhungo ukuze unciphise amaphutha ekusetshenzisweni okuphephile kwe-NorePinephryphrine (kanye nezinye i-vasopresresror):
Khawulela ukugxila. Ihlelwe inani elilinganiselwe lokugxila kokwelashwa kweziguli zezingane kanye / noma neziguli ezindala. Cacisa umkhawulo wesisindo wokufakwa okugxilwe kakhulu ukuze ubekelwe iziguli ezinomkhawulo we-fluid noma odinga imithamo ephakeme ye-norepinephrine (ukunciphisa izinguquko zesikhwama).
Khetha indlela eyodwa ye-dosing. Yenza ukukhiqizwa kokumiswa kwe-NorePinephPhrine njengokususelwa kwesisindo somzimba (MCG / KG / Min) noma ngaphandle kwalo (MCG / Min) ukunciphisa ubungozi bephutha. I-American Society of Health System Oparmacists (ASHP) Izindinganiso Zokuphepha Amazinga Wezokuphepha Ezinye izibhedlela zingahle zimise umthamo kuma-micrograms ngomzuzu ngokuya ngokuthandwa ngudokotela - zombili zamukelekile, kepha izinketho ezimbili ze-dosing azivunyelwe.
Kudinga ukunqunywa ngokuya nge-template ye-oda elijwayelekile. Dinga ukunikezwa kukadokotela we-NorePinephPrine usebenzisa ithempulethi yoku-oda evamile enezinkambu ezidingekayo zokuhlushwa okufunwayo, isizatho sokuthathwa kwegazi (isib. noma phansi), indlela yokuphatha kanye nomthamo omkhulu okungafanele kwedlulwe futhi / noma udokotela ohambile kufanele abizwe. Isikhathi sokuguqula okuzenzakalelayo kufanele kube "stat" yale miyalo ukuze uthathe phambili kulayini wekhemisi.
Khawulela imiyalo yamazwi. Khawulela imiyalo yamazwi ezimeni eziphuthumayo zangempela noma lapho udokotela engakwazi ukungena noma abhale i-oda nge-elekthronikhi. Odokotela kumele benze amalungiselelo abo ngaphandle kokuthi kube nezimo ezandulelayo.
Thenga izisombululo ezenziwe ngomumo lapho zitholakala. Sebenzisa ukugxila kwezixazululo ze-NorePinephRine ezihlanganisiwe ezivela kubakhiqizi kanye / noma izixazululo ezilungiselelwe abathengisi beminyaka yesithathu (njenge-503b) ukwehlisa ukubambezeleka kokwelashwa, futhi uvikele amaphutha ekhemisi.
ukuhlushwa okuhlukile. Hlukanisa ukugxila okuhlukile ngokubenza bahluke ngokuphelele ngaphambi kwe-dosing.
Nikeza ngamazinga anele we-ADC. Qoqa ku-ADC futhi unikeze nge-norepinephryfrine yokwanele yokuhlangabezana nezidingo zesiguli. Ukuqapha ukusetshenziswa kanye nokwenza ukulungisa amazinga ajwayelekile njengoba kudingeka.
Dala izinqubo zokusebenza kwe-batch kanye / noma ukuhlanganisa okufunwayo. Ngoba kungathatha isikhathi ukuxubana okuhlushwa okuphezulu okungashintshiwe, amakhemisi angasebenzisa amasu ahlukahlukene okubeka phambili ukulungiselela okufika ngesikhathi nokubeletha, okubandakanya ukudonsa kanye / noma ukucindezela lapho iziqukathi zingenalutho kungakapheli amahora, zigqugquzelwa yindawo yokunakekelwa noma nge-imeyili kulungiselelwe.
Iphakheji ngalinye / i-vial iskenwa. Ukugwema amaphutha ngesikhathi sokulungiselela, ukusatshalaliswa, noma ukugcinwa, ukuskena ibhakhodi kusikhwama ngasinye se-NorePinephPRine noma i-vial ukuze iqinisekiswe ngaphambi kokulungiselela, ukusatshalaliswa, noma ukugcinwa kwi-ADC. Ama-Barcode angasetshenziswa kuphela kumalebula ahambisana ngqo nephakheji.
Bheka ilebula esikhwameni. Uma isikhwama esikhanyayo esikhanyayo sisetshenziswa ngesikhathi sokuhlola okujwayelekile kwe-dosing, ukufakwa kwe-norepinephrine kufanele kususwe okwesikhashana esikhwameni ukuze kuhlolwe. Ngenye indlela, faka isikhwama sokuvikelwa sokukhanya ngaphezulu kokufakwa ngaphambi kokuhlola bese uwubeka esikhwameni ngokushesha ngemuva kokuhlolwa.
Dala imihlahlandlela. Sungula imihlahlandlela (noma i-protocol) yokuthathwa komsindo okuthathwa kwe-NorePinephPrine (noma esinye isidakamizwa esingu-Testrated), kufaka phakathi ukugxila okujwayelekile, ama-depration wethamo elijwayelekile, imvamisa evikelekile ye-dose / isilinganiso, isisekelo, nokuqapha okudingekayo. Uma kungenzeka, xhumanisa izincomo kwi-ehlelweni yokubhalwa kwemithi erekhodiwe (Mar).
Sebenzisa iphampu smart. Zonke i-agininephphrine ye-NorePinephrine zifakwe futhi zithweswe amaphampu we-smart infusion nge-Dose iphutha lokunciphisa i-Dose (DERS) enikwe amandla ukuze kuvunyelwe ukunakekelwa kwezempilo kube yinzuzo yokuthola usizo, ukubalwa, noma amaphutha okuhlela.
Vumela ukuhambisana. Lapho kungenzeka, vumela i-BI-CETITAL Smart infusion pump ehambelana namarekhodi ezempilo e-elekthronikhi. Ukusebenzisana kuvumela amaphampu ahlolwe amasethingi wokumnika aqinisekisiwe anqunywe udokotela (okungenani ekuqaleni kokuthathwa) futhi akhulisa ukuqaphela kwamakhemisi ukuthi malini ashiywe ku-infusions eshisiwe.
Maka imigqa bese ulandelela amapayipi. Faka ilebuli umugqa ngamunye wokusithela ngaphezulu kwephampu futhi eduze kwendawo yokufinyelela yesiguli. Ngaphezu kwalokho, ngaphambi kokuqala noma ukuguqula isilinganiselo se-NorePinephrine noma isilinganiso sokumnika, umzila ngesandla, umzila we-tubing kusuka esitsheni sezixazululo uye kwiphampu kanye nesiguli ukuqinisekisa ukuthi iphampu / isiteshi kanye nendlela yokuphatha ilungile.
Yamukela ukuhlolwa. Lapho ukumiswa okusha kumiswa, ukuhlolwa kwezobuchwepheshe (isib. Ibhakhodi) kuyadingeka ukuqinisekisa umuthi / isisombululo, ukugxilisa izidakamizwa kanye nesiguli.
Misa ukumnika. Uma isiguli sizinzile kungakapheli amahora ama-2 okuyekisa ukumnika kwe-NorePinePhephrine, cabanga ngokuthola umyalo wokunqamula kudokotela olapha. Lapho ukumnika sekumisiwe, nqamula ngokushesha ukumnika okuvela esigulini, kususe ephampu, bese ulahla ukugwema ukuphathwa ngengozi. Ukufakwa kufanele futhi kunqanyulwe esigulini uma ukumnika kuphazanyiswa isikhathi esingaphezu kwamahora ama-2.
Setha iphrothokholi ye-extravation. Setha iphrothokholi ye-Extravations ye-NorePinephRine efrijini. Abahlengikazi kufanele baziswe ngalolu hlelo, kufaka phakathi ukwelashwa nge-Phentelamine Mesylate kanye nokugwema ama-Cold Compression endaweni ethintekile, okungakhulisa ukulimala kwezicubu.
Hlaziya umkhuba wokubhala. Gada abasebenzi abalandelwa izincomo zokufakwa kwe-NorePinephRine, amaphrothokholi kanye nemiyalelo ethile yodokotela, kanye nemiphumela yeziguli. Izibonelo zezinyathelo zifaka ukuhambisana namapharamitha okubanjwa adingekayo ukuze ku-oda; ukubambezeleka ekwelashweni; Ukusetshenziswa kwamaphampu ahlakaniphile anikwe amandla ama-DERS (kanye nokusebenzisana); Qala ukumnika ngesilinganiso esinqunyelwe kusengaphambili; Ukutholwa ngokusho kwemvamisa ebekiwe kanye namapharamitha okuhlanza; I-Smart Pump ikuxwayisa imvamisa kanye nohlobo lomthamo, imibhalo yamapharamitha okutholwa (kufanele ifane nokushintsha kwesivinini) nokulimala kweziguli ngesikhathi sokwelashwa.