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完整後設資料紀錄
DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 林慧玲 | |
dc.contributor.author | Wei-Cheng Shao | en |
dc.contributor.author | 邵偉城 | zh_TW |
dc.date.accessioned | 2021-06-07T18:00:18Z | - |
dc.date.copyright | 2012-09-18 | |
dc.date.issued | 2012 | |
dc.date.submitted | 2012-08-07 | |
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dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/16079 | - |
dc.description.abstract | 研究背景
醫藥錯誤(medication error)是造成治療效果變差、失敗或是對病人造成傷害甚至死亡的重要原因,藥品注射劑型又比口服劑型更容易造成醫藥錯誤。給與注射劑藥品時發生的醫藥錯誤型態中,潛在藥品物化性質不相容(incompatible)的機率可高達25%,且造成的傷害多為中至重度甚至危及生命(life-threatening)。分析臺大醫院13個加護病房的電子醫令開方檔,排名前10名的不相容靜脈注射藥品組合中,有4項包含了furosemide,文獻回顧其Y-site相容性發現,furosemide或其他藥品的濃度與臺灣臨床使用不同,許多文獻的相容性資料無法應用在臺灣。 研究目的 探討加護及重症病房常用靜脈注射藥與furosemide的物理相容性研究,以及探討加護及重症病房常用靜脈注射藥與另一個較安定的環利尿劑bumetanide的物理相容性研究。 研究材料與方法 經由對加護病房中與loop diuretics可能同時給與之藥品的調查以及文獻回顧,共篩選出33種藥品、94組實驗組合。臨床上若藥品以原濃度給藥,則不稀釋;若須稀釋則稀釋液使用5 % dextrose (D5W)及0.9 % NaCl(NS)兩種,除非其一為不相容。濃度則選擇臨床最常用之1或2種濃度。 依Allen等人之模擬Y-site給藥方法,將配製好的藥品經0.22 μm薄膜過濾,取10 mL測量pH值,取20 mL當作對照組,並將利尿劑與其他藥品各取70 mL以1:1等體積混合,置入透明的圓柱型玻璃瓶中,於0-15分鐘、1小時及4小時進行肉眼觀察、pH測量及光阻微粒物質測計法檢驗,並以相反添加順序再測一次0-15分鐘內的結果,以測試相容性的再現性。肉眼觀察到任何變化(不包含廷得耳效應)或是光阻微粒物質測計法結果不符合藥典規定則定義為不相容。 研究結果 Furosemide 10 mg/mL與13種藥品(39.4%)、29組藥品組合(30.9%)產生肉眼可見不相容,以混濁或產生沉澱、懸浮微粒為最常見之變化,唯一產生顏色變化者為metronidazole 5 mg/mL undiluted由無色澄清轉為淺黃色澄清。除肉眼觀察的13種藥品外,另有teicoplanin及lorazepam,共15種藥品(45.5%)、35組藥品組合(37.2%)沒有通過藥典的大體積注射藥品(LVPs)微粒物質檢定(每mL微粒物質≥10 μm者不得大於25個,且每mL微粒物質≥25 μm者不大於3個),幾乎所有不相容混合後可以馬上發現。 Bumetanide 0.5 mg/mL與6種藥品(18.2%)、16組藥品組合(17.0%)產生肉眼可見不相容,以顏色改變為最常見之變化,皆為變成淺黃色澄清。此外,共6種藥品(18.2%)、9組藥品組合(9.6%)沒有通過藥典的大體積注射藥品(LVPs)微粒物質檢定,僅有不到一半比例的不相容藥品對是肉眼立即可觀察到(37.5%),較多變化需要混合1小時後才能觀察到。 33種藥品之中,共有9種藥與furosemide混合會發生不相容,但與bumetanide混合給藥則不會發生;相反的情形則有dopamine HCl及esomeprazole sodium 2種藥品。而33種藥品中,amiodarone HCl、dobutamine HCl、labetalol HCl、lorazepam、nicardipine HCl、teicoplanin共6種藥品在特定濃度及稀釋液條件下對2種loop diuretics都是不相容。 若選擇了2種藥品都相容的稀釋液,則稀釋液的選擇較不會影響到Y-site相容性;而在臨床常用的濃度之下,相容性與濃度也沒有明顯相關;最重要影響相容性的因素為藥品混合前的pH值差異,OR (odds ratio)為1.74 (95% CI=1.36-2.23),代表若藥品混合前pH值差異每增加1單位,不相容的odds增加74%。 肉眼觀察與微粒物質檢查結果並非完全一致,仍然有藥品混合後是肉眼觀察不出異狀但微粒物質檢查卻未通過,對病人而言可能是潛在的風險,為避免發生不希望的藥品不良事件,建議Y-site相容性研究應使用肉眼觀察配合particle counter進行微粒物質檢測。 結論 Furosemide和ICUs常用藥品高度不相容,應避免與其他藥品一同給與,給藥前後都應以至少5-6倍管內體積的相容稀釋液沖洗管路;若同時給藥無法避免,則有9種藥品在給藥時,furosemide可替換為bumetanide,而非本研究實驗之其餘藥品仍應有文獻證明相容性,且給與後必須觀察有無不相容,尤其是長時間輸注時要特別注意變色等不相容情形發生。 | zh_TW |
dc.description.abstract | Background
Medication error is the leading cause of treatment failures, harms or deaths. The intravenous (i.v.) medications carry higher risk of medication error than oral medications. Potential physicochemical incompatibilities accounted for up to 25% of medication errors during i.v. administration, and most harms were moderate to severe, even life-threating. According to a study on the computerized physician’s order entry of thirteen intensive care units (ICUs) in National Taiwan University Hospital, four of the ten most frequently encountered incompatible pairs contained furosemide. A literature review on Y-site compatibility of furosemide found that concentration of furosemide and other drugs are different from those used in our hospital. Therefore, these compatibility data cannot be applied in Taiwan. Objective To study simulated Y-site physical compatibility of furosemide with selected i.v. medications, and simulated Y-site compatibility of bumetanide with the same selected medications. Materials and Methods Through a survey of i.v. drugs used currently with loop diuretics in ICUs and literature review, 33 drugs and 94 pairs were selected. If a drug needs to dilute before administrating, 5 % dextrose and 0.9 % NaCl solution were used, unless one of them is incompatible. All drugs were diluted to one to two most commonly used concentrations. A simulated Y-site co-administration model develop by Allen et al was adopted. Ten milliliter of each solution was used to measure pH value, and 20 mL as the control. Seventy milliliters of one of the diuretics was mixed with 70 mL of a selective drug in a colorless glass cylinder. All prepared solutions were filtered through a 0.22 μm filter before mixing. After mixing, we inspected the mixture at 0 to 15 minutes, 1 hour and 4 hour by visual inspection, pH measurement and light obscuration particle count test. The order of mixing was reversed and a second inspection was done at 0 to 15 minutes to explore the reproducibility. Any visual change, such as particulate matter, turbidity or color change as compared to the control solutions was defined as incompatible. Mixtures that failed in the particle counter test were also defined as incompatible. Results Furosemide 10 mg/mL was visually incompatible with 13 drugs (39.4%) and 29 drug pairs (30.9%). Turbidity, precipitation, particulate formation were the predominant phenomena. Admixture of furosemide and metronidazole 5 mg/mL was the only one that showed color change, which turned from colorless to light yellow. Fifteen drugs (45.5%) and 35 drug pairs (37.2%) failed the particle counter test, including teicoplanin, lorazepam and 13 visually incompatible drugs. All incompatibilities were detected immediately after mixing. Bumetanide 0.5 mg/mL was visually incompatible with 6 drugs (18.2%) and 16 drug pairs (17.0%), and color change was most frequently observed. Six drugs (18.2%) and 9 drug pairs (9.6%) failed in the particle counter test. Most incompatibility occurred 1 hour after mixing, and only 37.5% were detected immediately. Nine drugs that were incompatible with furosemide were compatible with bumetanide, while dopamine HCl and esomeprazole sodium had the opposite results. With the specific diluents and concentrations we used, 6 drugs were incompatible with both diuretics, which include amiodarone HCl, dobutamine HCl, labetalol HCl, lorazepam, nicardipine HCl and teicoplanin. The choice of diluent did not influence Y-site compatibility, if the diluent is compatible with both i.v. drugs. There was no correlation between commonly used concentration and compatibility either. The pH difference between two drugs before mixing was the most important risk factor for incompatibility (OR=1.74, 95% CI=1.36-2.23). For every pH difference increament by 1, the odds of incompatibility increased by 74%. There were inconsistent results between visual inspection and particle counter tests. Some mixtures passed the visual inspection but failed in the particle test. They may harm the patients. To avoid these unexpected events, particle counter test should be used concurrently with visual inspection in Y-site compatibility study. Conclusions Furosemide is highly incompatible with i.v. medications frequently used ICUs, and should not be administered concurrently with other drugs. The intravenous catheter should be flushed at volume of 5 to 6 times the volume of tubing with compatible diluent before and after administering furosemide. There are nine drugs that are incompatible with furosemide but compatible with bumetanide. When co-administration with these 9 drugs is unavoidable, bumetanide may be an alternative of furosemide. However, we must inspect any incompatibility during administering bumetanide, especially color change that may occur during prolonged infusion with other drugs | en |
dc.description.provenance | Made available in DSpace on 2021-06-07T18:00:18Z (GMT). No. of bitstreams: 1 ntu-101-R99451007-1.pdf: 1865295 bytes, checksum: 5205eccdb30bddbffed18f2f506d7a4a (MD5) Previous issue date: 2012 | en |
dc.description.tableofcontents | 致謝 ii
中文摘要 iii Abstract vi 目錄 ix 圖次 xiii 表次 xiv 附錄 xv 中英文對照表 xvii 第1章 前言 1 第2章 文獻回顧 2 2.1藥品相容性 2 2.2 模擬Y-site給藥之物理相容性研究 2 2.3 藥品物化不相容的機轉 4 2.3.1 酸鹼反應(acid–base reactions) 4 2.3.2 產生有機離子非解離鹽類(nondissociated salt of organic ion) 4 2.3.3鹽析(salting out) 5 2.3.4形成非有機二價離子鹽(salts of inorganic divalent ions) 5 2.3.5非游離有機藥品的去溶劑化(desolvation of nonionized organic drugs) 5 2.3.6形成有機與非有機離子鹽類 5 2.4 臺大醫院電子醫令開方檔相容性分析 5 2.5 臺大醫院護理人員注射劑給藥作業問卷調查 6 2.6 Furosemide 7 2.6.1 藥品簡介 7 2.6.2 物化性質 7 2.6.3 安定性 7 2.6.4 產品儲存條件 8 2.7 Furosemide的Y-site相容性資料 8 第3章 研究目的 10 第4章 研究材料及方法 11 4.1 材料 11 4.2 研究方法 12 4.2.1 藥品選擇 12 4.2.1.1護理人員問卷 12 納入 12 排除 12 4.2.1.2 臺大醫院2009/7/31-2009/12/31電子醫令開方檔 13 納入 13 排除 13 4.2.2 藥品溶液配製及稀釋液 13 4.2.3模擬Y-site給藥之物理不相容性實驗 14 4.2.3.1 肉眼觀察 14 4.2.3.2 廷得耳實驗 14 4.2.3.3 pH值 15 4.2.3.4 光阻微粒物質測計法 15 一般注意事項 15 測定法 15 容許範圍 16 4.2.4 相容性結果判讀 16 4.3 統計分析 16 4.3.1 研究方法比較 16 4.3.2 影響相容性危險因子分析 16 第5章 研究結果 17 5.1實驗溫度 17 5.2無微粒物質水測試 17 5.3 Furosemide物理相容性 17 5.3.1 肉眼觀察 17 5.3.2 光阻微粒物質測計法 18 5.3.3 肉眼觀察法及光阻微粒物質測計法之比較 19 5.3.4 更改混合順序之再現性 19 5.4 Bumetanide物理相容性 19 5.4.1 肉眼觀察 19 5.4.2 光阻微粒物質測計法 20 5.4.3 肉眼觀察法及光阻微粒物質測計法之比較 21 5.4.4更改混合順序之再現性 21 5.5 Loop diuretics物理相容性比較 21 5.6 Tyndall test 22 5.7物理相容性各檢測方法比較 22 5.8 影響相容性之因素 24 5.8.1稀釋液 24 5.8.2 濃度 24 5.8.3 毫莫耳濃度(分子數目) 24 5.8.4 溶解度 24 5.8.5 pH 25 第6章 討論 26 6.1 Furosemide與ICUs常用藥品之物理相容性 26 6.2 Bumetanide與ICUs常用藥品之物理相容性 29 6.3 高度不相容藥品 30 6.4 相容性結果與護理人員經驗歧異度 31 6.5 Tyndall test 31 6.6 微粒物質檢查在物理相容性的重要性 32 6.7 研究限制 34 第7章 結論 35 圖表 37 附錄 83 參考文獻 123 | |
dc.language.iso | zh-TW | |
dc.title | 環利尿劑與加護病房中常用靜脈注射藥之物理不相容性研究 | zh_TW |
dc.title | Physical Incompatibilities of Loop Diuretics with Intravenous Medications Frequently Used in Intensive Care Units | en |
dc.type | Thesis | |
dc.date.schoolyear | 100-2 | |
dc.description.degree | 碩士 | |
dc.contributor.oralexamcommittee | 沈麗娟,高純琇 | |
dc.subject.keyword | 醫藥錯誤,furosemide,bumetanide,相容性,Y-site, | zh_TW |
dc.subject.keyword | Medication error,furosemide,bumetanide,compatibility,Y-site, | en |
dc.relation.page | 126 | |
dc.rights.note | 未授權 | |
dc.date.accepted | 2012-08-07 | |
dc.contributor.author-college | 醫學院 | zh_TW |
dc.contributor.author-dept | 臨床藥學研究所 | zh_TW |
顯示於系所單位: | 臨床藥學研究所 |
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