Amakuru

IKIBAZO: Norepinephrine ni imiti iboneka cyane itangwa neza (IV) nkizuba rihoraho. Ni Vasoprestor ikunze gutwarwa no gukomeza umuvuduko ukabije wamaraso hamwe na prece stfusi yumuryango urwaye cyane hamwe nabana bafite indyarya ikabije nubwo ukomeza ubwenge bukabije nubwo buhagije. Ndetse amakosa mato mu masomo cyangwa igipimo, kimwe no gutinda kuvurwa, birashobora kuganisha ku ngaruka mbi. Sisitemu y'ubuzima bw'isi ya benshi yohereje ibisubizo by'isesengura risanzwe (CCA) ku makosa 106 na 2021. Gushakisha ibintu byinshi hamwe na CCA bituma amashyirahamwe aterana imizi na sisitemu. Amakuru yo kuri gahunda yo gutanga raporo hamwe na pope ya Smart Ubwenge yakoreshejwe mukumenya amakosa.
ISMP yakiriye raporo 16 zijyanye na 2020 na 2021 binyuze muri gahunda yigihugu yo gutanga amakuru yigihugu (ISmp Merp). Kimwe cya gatatu cyizi raporo zakemuye akaga kijyanye n'amazina asa, ibirango, cyangwa gupakira, ariko nta makosa yabitangaje. Twasohoye raporo z'ikosa ririndwi rya Norepinephrine: Amakosa ane yo gufatanya (ku ya 16 Mata 2020; ku ya 26 Kanama, 2021; 24 Gashyantare, 2022); ikosa rimwe ryo kwibandaho nabi; ikosa rimwe ryigiciro kibi cyibiyobyabwenge; guhagarika impanuka yo guhagarika norepinephrine. Raporo 16 zose zongewe muri sisitemu yubuzima bwa CCA (N = 106) hamwe nibisubizo byakemutse (n = 122) kuri buri ntambwe mubikorwa byo gukoresha ibiyobyabwenge byerekanwe hepfo. Ikosa ryavuzwe ririmo gutanga urugero rwimpamvu zimwe zisanzwe.
Andika. Twabonye ibintu byinshi byo gukusanya bifitanye isano no kwandikwa amakosa, harimo no gukoresha bitari ngombwa byo gukoresha amategeko mu kanwa, kugena ibikoresho bya Norepinephrine bidafite imikoreshereze yashyizweho, kandi intego zidasobanutse cyangwa ngo zidasobanutse neza (cyane cyane niba amategeko adakoreshwa). Rimwe na rimwe, ibipimo by'igihangano byateganijwe cyangwa bidahwitse (urugero, byiyongera cyane ni binini), bikagora abaforomo kubyubahiriza mugihe bakurikirana umuvuduko w'amaraso y'umurwayi. Mu bindi bihe, abaganga barashobora kugena ibiro bishingiye ku buremere cyangwa bushingiye ku buremere, ariko rimwe na rimwe byitiranya. Iyi-yo-agasanduku-agasanduku yongera amahirwe yabaganga bato bamanutse bakora amakosa, harimo amakosa ya Pompe, kubera ko amahitamo abiri aboneka mubitabo bya pompe. Byongeye kandi, gutinda byavuzwe gusaba ibisobanuro mugihe hashyizweho amabwiriza ashingiye ku buremere hamwe n'amabwiriza ashingiye ku buremere.
Muganga arasaba umuforomo kwandika inyandiko kuri Norepinephrine kumurwayi ufite umuvuduko wamaraso udahungabana. Umuforomokazi yinjiye muri gahunda neza nkuko umuganga yatumije mu magambo ateganijwe: 0.05 MCG / KG / Min IV yagenewe intego isobanura umuvuduko w'Abahanzi (Ikarita) hejuru ya 65 MMHG. Ariko umuganga wa dosage ya dosage avanga ibipimo bishingiye ku buremere bishingiye ku buremere bushingiye ku gipimo ntarengwa: 19 MCG / min buri minota 5 mcg / kg / min. Pompe yubwenge ya SMART yashoboye gutwika MCG / min dose kuri Dose ntarengwa, MCG / KG / Min. Abafarumasiye bagombaga kugenzura amabwiriza nabaganga, byatumye batabitaho.
Gutegura no gukwirakwiza. Kwitegura cyane no gufata amakosa biterwa na farumasi ikabije, bikabije nabakozi ba farumasi bisaba kwibanda cyane norepinephrine intangarugero (32 mg / 250 ml) (ziboneka kuri farumasi ya 503b ariko ntabwo iboneka ahantu hose). biganisha ku munyuzi n'umunaniro. Izindi mpamvu zitera amakosa zirimo ibirango bya Noradrenaline byihishe mumifuka ifatanye no kutisobanukirwa abakozi ba farumasiyo byihutirwa.
CO-CHAMSION ya Norepinephrine na Nicupipine mumufuka wijimye wijimye wagenze nabi. Kubangamiye byijimye, sisitemu yo gufatanya yacapwe labels ebyiri, imwe kumufuka wimuvura nundi hanze yumufuka wa amber. Norepinephrine Guterwa no kwashyirwa mu mapaki ya Amber yanditseho "Nickandupi" mbere yo gukwirakwiza ibicuruzwa gukoreshwa n'abarwayi batandukanye n'udukoko. Amakosa ntabwo yabonetse mbere yo gutanga cyangwa guhagarara. Umurwayi yavuwe na Nicardipne yahawe Norepinephrine ariko ntiyateje ingaruka ndende.
ubuyobozi. Amakosa asanzwe arimo dose itari yo cyangwa ikosa ryibandaho, igipimo kidasanzwe, n'amakosa y'ibiyobyabwenge atari yo. Ibyinshi muribi byateganijwe biterwa na gahunda itari yo yo gufatanya na pompe ya SMART, igice kubera ko habaho guhitamo ibiyobyabwenge mubitabo byibiyobyabwenge, haba muburemere kandi butayifite; amakosa yo kubika; Guhuza no kongera guhura kwagabanijwe cyangwa guhagarikwa kwamurwayi byatangiye kwiyuhagira nabi cyangwa kutaranga umurongo kandi ntibyabakurikiye mugihe utangiye cyangwa usunika kwimuka cyangwa gusubukura. Ikintu kitagenze neza mubyumba byihutirwa nibice bikora, hamwe na pompe yubwenge hamwe ninyandiko zubuzima za elegitoronike (EHR) ntizaboneka. Kureka kuganisha ku kwangirika kw'imirenge nabyo byatangajwe.
Umuforomokazi yatanze Norepinephrine nkuko byerekanwe ku gipimo cya 0.1 μg / kg / min. Aho gutangiza pompe yo gutanga 0.1 mcg / kg / min, umuforomo wateguye pompe yo gutanga 0.1 mcg / min. Kubera iyo mpamvu, umurwayi yakiriye inshuro 80 Notrepinefine kuruta iyabigenewe. Iyo infusion iragenda iragaruka buhoro buhoro ikagera ku gipimo cya 1.5 μg /n Kuberako umurwayi asobanura igitutu kidasanzwe, Vasopressor ya kabiri yongeyeho.
Ibarura n'ububiko. Amakosa menshi abaho mugihe yuzuza akabati kaguta mu buryo bwikora (ADCs) cyangwa guhindura Norepinephrine vial mu magare ya code. Impamvu nyamukuru yaya makosa yo kubara ni labeling imwe kandi ipakira. Ariko, izindi mpamvu zisanzwe zaramenyekanye, nkinzego nke za Norepinephrine gutera inkunga ishami ryishinzwe kwihangana, biganisha ku gutinda kwivuza, biganisha ku bya farumasi byagombaga guhitana ibintu bitewe nabuze. Kunanirwa gusikana barcode ya buri gicuruzwa cya Norepinephrine mugihe cyo kubika ADC nubundi buryo busanzwe bwikosa.
Umufarumasiye yibeshye adc hamwe na farumasi-yateguye 32 MG / 250 ML NorepinePhine Igisubizo cya 4 MG / 250 Ml Premix Premix. Umuforomokazi yahuye nikosa mugihe agerageza kwakira 4 MG / 250 ml Norepinephrine incusine ya ADC. Barcode kuri buri mushitsi ku giti cye ntabwo yasuzumwe mbere yo gushyirwa muri ADC. Umuforomokazi amaze kubona ko muri MG / 250 gusa muri ADC hari 32 muri ADC (igomba kuba mu gice cya firigo ya ADC), yasabye kwibanda. Norepinephrine 4mg / 250ml ibisubizo bya inflesion ntabwo iboneka muri farumasi kubera kubura parike ya 4Mg / 250ml, bikavamo gutinda kuvanga infusion.
monitor. Gukurikirana nabi abarwayi, imigambi ya Norepinephine Gutunganiza hanze Ibipimo byo hanze, kandi ntibitegerejwe mugihe umufuka wa infusika ukurikira nimpamvu nyamukuru itera amakosa yo gukurikirana amakosa.
Umurwayi upfa ufite amategeko yo "Ntugahunge" yatewe na Norepinephrine kugirango ahembye igihe gihagije kumuryango we gusezera. Norepinephrine fusion yarangiye, kandi nta gikapu cyimifuka hariya muri ADC. Umuforomo yahise yita farumasi anasaba igikapu gishya. Farumasi ntabwo yari afite umwanya wo gutegura imiti mbere yuko umurwayi yitange maze asezera kumuryango we.
Akaga. Ibyago byose bitavuyemo ikosa rivugwa kuri Ismp kandi ririmo amazina asa cyangwa amazina yibiyobyabwenge. Raporo nyinshi zerekana ko gupakira no kubiramo ibintu bitandukanye byo kwibanda kuri Norepinephrine guhungabanya nomero ya 503b bigaragara ko bisa nkaho bisa.
Ibyifuzo byimyitozo itekanye. Suzuma ibyifuzo bikurikira mugihe ukura cyangwa usubiramo ingamba za kilometero yawe kugirango ugabanye amakosa mugukoresha umutekano wa NorepinePhine (nizindi vaspinephrine (hamwe nizindi vaspinephrine (hamwe nizindi vaspinephrine (
kugabanya kwibanda. Bisanzwe kumubare ntarengwa wo kwibanda kubuvuzi bwabacuruza nabakuze. Kugaragaza uburemere bwimibare yibanze cyane kugirango bigerwe kubarwayi bafite amakimbirane cyangwa bisaba dosiye yo hejuru ya Norepinephrine (kugirango igabanye impinduka).
Hitamo uburyo bumwe. Ibisanzwe NotrepinePhine Impunzi zishingiye ku buremere bw'umubiri (MCG / kg / min) cyangwa bitabaye (mcg / min) kugirango ugabanye ibyago. Umuryango wabanyamerika wa sisitemu yubuzima (ASHP) Ibipimo byumutekano4 birasaba gukoresha ibipimo bya Norepinephrine muri micrograms / kg / kumunota. Ibitaro bimwe bishobora kumenyera dosage kuri microgramu kumunota bitewe nuburyo bwa muganga - byombi biremewe, ariko amahitamo abiri yo gukora ntabwo yemerewe.
Bisaba kubandikira ukurikije icyitegererezo gisanzwe. Bisaba norepinephine infuption ya norepinephyine ukoresheje icyitegererezo gisanzwe hamwe nimirima isabwa kubitekerezo byifuzo byo kwifuza, intego yo kwiyongera, hamwe nigipimo cyamamara Igihe gisanzwe kigenda kigomba kuba "status" kuri aya mabwiriza yo gufata umwanya wa farumasi.
Kugabanya amabwiriza. Gabanya amabwiriza yamagambo kubintu byihutirwa cyangwa mugihe umuganga adashobora kwinjira cyangwa kwandika itegeko rya elegitoroniki. Abaganga bagomba kwishyiriraho gahunda zabo keretse niba hari aho ushimangira.
Gura ibisubizo byiteguye mugihe bihari. Koresha kwibanda kuri mbere ya Norepinephrine ibisubizo byabakora na / cyangwa ibisubizo byateguwe nabacuruzi baho (nka 503b) kugirango bagabanye igihe cyo kwitegura farumasi, kandi wirinde amakosa yo kwivuza.
kwibanda. Gutandukanya ibitekerezo bitandukanye ubatuma batandukana mbere yo gukanda.
Gutanga urwego ruhagije rwa ADC. Shyira kuri ADC kandi utange igitero gihagije cyo guhuriza hamwe kugirango uhuze abarwayi. Gukurikirana imikoreshereze kandi uhindure urwego rusanzwe nkuko bikenewe.
Kora inzira kubikoresho byo gutunganya no / cyangwa guterana kubisabwa. Kuberako bishobora gufata igihe cyo kuvanga kwibanda kubisanzwe, farumasi zirashobora gukoresha ingamba zitandukanye zo gushyira mubikorwa byo gutegura no gutanga
Buri paki / Valial irasuzugura. Kugira ngo wirinde amakosa mugihe cyo kwitegura, gukwirakwiza, cyangwa kubika, gusikana barcode kuri buri gikapu cya norepinephine mbere yo kwitegura, gukwirakwiza, cyangwa kubika muri ADC. Barcode irashobora gukoreshwa gusa kumurongo ushyizwe kuri paki.
Reba ikirango kumufuka. Niba igikapu gikomeye gikoreshwa mugihe cyo kugenzura gahunda zisanzwe, Norepinephrine Infusion igomba gukurwa by'agateganyo mu gikapu cyo kwipimisha. Ubundi, shyira igikapu cyo kurinda urumuri hejuru yizuba mbere yo kugerageza hanyuma ubishyire mumufuka ako kanya nyuma yo kwipimisha.
Shiraho umurongo ngenderwaho. Shiraho umurongo ngenderwaho (cyangwa protocole) kugirango ushiremo imitwe ya Noresine), hashize imiti yiyongera, ibiganiro bisanzwe byiyongera, ibiganiro byigihangano byiyongera, ibiganiro byigihangano byiyongera, ibipimo ngenderwaho / igipimo, icyiciro, no kugenzura bisabwa. Niba bishoboka, guhuza ibyifuzo kuri gahunda yigiterekori mumiti (Werurwe).
Koresha pompe yubwenge. Gutungura Norepinephrine kandi byatewe no gukoresha pompe ya Smart Infucle hamwe na sisitemu yo kugabanya amakosa (ders) byashobotse kugirango ibyo bishoboke bishobora kumenyesha inzego zubuzima kurushaho kubahiriza, kubara, cyangwa amakosa yo gutabara.
Gushoboza guhuza. Aho bishoboka, ushoboze pompe ya bi-icyerekezo cya Wi-Icyerekezo gihuye ninyandiko zubuzima bwa elegitoronike. Imikoranire yemerera pompe kugirango imenyere igenamiterere rya infusian ryagenzuwe na muganga (byibuze mugitangira cyigihangano) kandi niwongera imigambi ya farumasi kumwanya wa Tirumo.
Shyira imirongo hanyuma ukurikira imiyoboro. Andika buri murongo wa infusion hejuru ya pompe kandi hafi yicyerekezo cyo kwinjira. Byongeye kandi, mbere yo gutangira cyangwa guhindura umufuka wa NorepinePhine cyangwa igipimo cyintoki, inzira yintoki igiti cyo kumuti wabigenewe kugeza kuri pompe no kwihangana kugirango umenye ko pompe / umuyoboro hamwe ninzira yubuyobozi aribyo.
Emera kugenzura. Iyo infusic nshya ihagarikwa, ubugenzuzi bwa tekiniki (urugero barcode) isabwa kugenzura ibiyobyabwenge / igisubizo, kwibanda ku miti no kwihangana.
Hagarika kwiyuhagira. Niba umurwayi ahagaze mugihe cyamasaha 2 yo guhagarika norepinephrine notrepinephrine, tekereza kubona gahunda yo guhagarika muri profisian. Imvura imaze guhagarara, ako kanya uhagarike kwinjiza umurwayi, ukureho pompe, hanyuma uhitemo kwirinda ubuyobozi bwimpanuka. Infusion nayo igomba gucika intege kubarwayi niba incusi ihagarikwa kumasaha arenga 2.
Shiraho protocole idasanzwe. Shiraho protocole idasanzwe kugirango adafite agaciro norepinephrine. Abaforomo bagomba kumenyeshwa kuri iri tegeko, harimo no kuvura hamwe na Photolamine Mesylate kandi bakirinda imitekerereze ikonje ku gace katewe, bishobora kongera kwangirika kw'imiti.
Gusuzuma imyitozo ngororamubiri. Kurikirana abakozi bubahiriza ibyifuzo kuri Norepinephrine infusion, protocole hamwe nibisobanuro byihariye bya siyansi, ndetse no kurangiza kwihangana. Ingero zingamba zirimo kubahiriza ibipimo byigihangano bisabwa kugirango birinda; gutinda kuvura; Gukoresha Pumps yubwenge hamwe na ders ishoboye (kandi imikoranire); Tangira kwizuba kurwego rwateganijwe; IGISITU Nkurikije inshuro zateganijwe no kunywa ibipimo; PRMP SHAM irakumenyesha inshuro nubwoko bwibipimo, ibyangombwa byigipimo cyigice (bigomba guhura nibitekerezo) no kwiyambaza mugihe cyo kuvura.