Background

Intravenous drug administration is associated with potential complications, such as phlebitis. The physiochemical characteristics of the infusate play a very important role in some of these problems.

Aim

The aim of this study was to standardize the dilutions of intravenous drugs most commonly used in hospitalized adult patients and to characterize their pH, osmolarity and cytotoxic nature to better guide the selection of the most appropriate vascular access.

Methods

The project was conducted in three phases: (i) standardization of intravenous therapy, which was conducted using a modified double-round Delphi method; (ii) characterization of the dilutions agreed on in the previous phase by means of determining the osmolarity and pH of each of the agreed concentrations, and recording the vesicant nature based on the information in literature; and (iii) algorithm proposal for selecting the most appropriate vascular access, taking into account the information gathered in the previous phases.

Results

In total, 112 drugs were standardized and 307 different admixtures were assessed for pH, osmolarity and vesicant nature. Of these, 123 admixtures (40%), had osmolarity values >600 mOsm/L, pH < 4 or > 9, or were classified as vesicants. In these cases, selection of the most suitable route of infusion and vascular access device is crucial to minimize the risk of phlebitis-type complications.

Conclusions

Increasing safety of intravenous therapy should be a priority in the healthcare settings. Knowing the characteristics of drugs to assess the risk involved in their administration related to their physicochemical nature may be useful to guide decision making regarding the most appropriate vascular access and devices.

中文翻译：

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成人患者静脉治疗的标准化和化学表征：药物安全性更进一步

 背景

静脉给药与潜在的并发症有关，例如静脉炎。输液的理化特性在其中一些问题中起着非常重要的作用。

 目的

本研究的目的是标准化住院成人患者最常用的静脉注射药物的稀释度，并表征其 pH 值、渗透压和细胞毒性性质，以更好地指导选择最合适的血管通路。

 方法

该项目分三个阶段进行：（i）静脉治疗标准化，采用改良的双轮德尔菲法进行； (ii) 通过确定每个商定浓度的渗透压和 pH 值来表征前一阶段商定的稀释度，并根据文献中的信息记录起泡剂的性质； (iii) 考虑前一阶段收集的信息，选择最合适的血管通路的算法建议。

 结果

总共对 112 种药物进行了标准化，并对 307 种不同混合物的 pH 值、渗透压和起泡性质进行了评估。其中，123 种混合物 (40%) 的渗透压值为 >600 mOsm/L，pH < 4 或 > 9，或被归类为起泡剂。在这些情况下，选择最合适的输注途径和血管通路装置对于最大限度地降低静脉炎型并发症的风险至关重要。

 结论

提高静脉治疗的安全性应成为医疗机构的首要任务。了解药物的特性以评估与其理化性质相关的给药风险可能有助于指导有关最合适的血管通路和装置的决策。