Amakuru

Ikibazo: Norepinephrine ni umuti uboneka cyane utangwa mu mitsi (IV) nk'umuti ukomeza guterwa. Ni umuti ugabanya umuvuduko w'amaraso ukunze guterwa kugira ngo ukomeze kugira umuvuduko w'amaraso uhagije no kugabanya urujya n'uruza rw'ingingo mu bantu bakuru barembye cyane n'abana bafite umuvuduko ukabije w'amaraso cyangwa shock ikomeza nubwo amazi yongeye kugabanuka. Ndetse n'amakosa mato mu guterwa cyangwa ku gipimo, ndetse no gutinda kuvurwa, bishobora gutera ingaruka mbi. Ikigo gishinzwe ubuzima cya Multicenter giherutse kohereza ISMP ibisubizo by'isesengura ry'impamvu rusange (CCA) ku makosa 106 ya norepinephrine yabaye mu 2020 na 2021. Gusuzuma ibintu byinshi hamwe na CCA bituma amashyirahamwe ashobora gukusanya impamvu rusange n'ingaruka mbi z'umubiri. Amakuru aturuka muri gahunda y'itanga raporo z'ikigo hamwe n'amapompo y'ikoranabuhanga yakoreshejwe mu kumenya amakosa ashobora kubaho.
ISMP yakiriye raporo 16 zijyanye na noradrenaline mu 2020 na 2021 binyuze muri gahunda ya ISMP National Medication Error Reporting Program (ISMP MERP). Hafi kimwe cya gatatu cy'izi raporo zavugaga ku ngaruka zijyanye n'amazina asa, ibyapa, cyangwa ipaki, ariko nta makosa yagaragaye. Twasohoye raporo z'amakosa arindwi y'abarwayi ba norepinephrine: amakosa ane yo gutanga (16 Mata 2020; 26 Kanama 2021; 24 Gashyantare 2022); ikosa rimwe ryo gupima nabi; ikosa rimwe ryo gufata umuti nabi; guhagarika guterwa norepinephrine mu buryo butunguranye. Raporo zose 16 za ISMP zongewe muri sisitemu y'ubuzima ya CCA (n = 106) kandi ibisubizo byakusanyijwe hamwe (N = 122) kuri buri ntambwe mu ikoreshwa ry'imiti bigaragara hano hepfo. Ikosa ryatangajwe ririmo kugira ngo ritange urugero rw'impamvu zimwe na zimwe zikunze kugaragara.
Gutanga imiti. Twabonye ibintu byinshi bitera amakosa yo gutanga imiti, harimo gukoresha amabwiriza yo mu kanwa bitari ngombwa, gutanga imiti ya norepinephrine nta mabwiriza akoreshwa, hamwe n'ibipimo bitazwi cyangwa bitazwi neza (cyane cyane iyo amatsinda y'amabwiriza adakoreshwa). Hari igihe ibipimo byatanzwe bya titration biba bikomeye cyane cyangwa bidashoboka (urugero, inyongera zatanzwe ziba nini cyane), bigatuma bigorana abaforomo gukurikiza iyo bakurikirana umuvuduko w'amaraso w'umurwayi. Mu bindi bihe, abaganga bashobora gutanga imiti ishingiye ku buremere cyangwa idashingiye ku buremere, ariko rimwe na rimwe ibi biravangwa. Uku gutanga imiti mu buryo budasanzwe byongera amahirwe y'abaganga bakora amakosa, harimo n'amakosa yo gukoresha pompe, kubera ko hari amahitamo abiri yo gutanga imiti mu isomero rya pompe. Byongeye kandi, gutinda byagaragaye ko bisaba ibisobanuro by'amabwiriza ubwo amabwiriza yo gutanga imiti yarimo amabwiriza yo gutanga imiti ashingiye ku buremere n'amabwiriza yo gutanga imiti ashingiye ku buremere.
Umuganga yasabye umuforomo kwandika urupapuro rwa norepinephrine ku murwayi ufite umuvuduko w'amaraso udahindagurika. Umuforomo yanditse urutonde nk'uko muganga yabitegetse mu kanwa: 0.05 mcg/kg/min IV titrated to a target mean arterial pressure (MAP) iri hejuru ya 65 mmHg. Ariko amabwiriza ya muganga avanga ibiciro bidashingiye ku buremere n'ibiciro ntarengwa bishingiye ku buremere: titrate ku gipimo cya 5 mcg/min buri minota 5 kugeza kuri dose ntarengwa ya 1.5 mcg/kg/min. Pompe y'ikigo y'ikoranabuhanga ntiyashoboye gushyira dose ya mcg/min kuri dose ntarengwa bishingiye ku buremere, mcg/kg/min. Abafarumasiye bagombaga kugenzura amabwiriza n'abaganga, byatumye batinda gutanga ubuvuzi.
Tegura kandi utange. Amakosa menshi yo gutegura no gutanga imiti aterwa n'umutwaro mwinshi w'imirimo yo muri farumasi, ukongera imbaraga z'abakozi ba farumasi basaba imiti ya norepinephrine (32 mg/250 ml) (iboneka muri farumasi ya 503B ariko ntiboneka ahantu hose). Bitera gukora ibintu byinshi bitandukanye no kunanirwa. Izindi mpamvu zikunze gutera amakosa yo gutanga imiti harimo ibirango bya noradrenaline bihishe mu mifuka idafunze neza ndetse n'abakozi ba farumasi badasobanukiwe neza ko gutanga imiti byihutirwa.
Guteranya norepinephrine na nicardipine mu gafuka k'umuhondo wijimye ntibyagenze neza. Ku guteramo umuhondo wijimye, uburyo bwo gutanga umuhondo bwanditseho ibirango bibiri, kimwe ku gafuka k'umuhondo ubwacyo ikindi inyuma y'agafuka k'umuhondo. Guteramo norepinephrine byashyizwe mu dupaki tw'umuhondo twanditseho "nicardipine" mbere yo gukwirakwiza umuti kugira ngo ukoreshwe n'abarwayi batandukanye, naho ibindi. Amakosa ntiyagaragaye mbere yo gutanga umuti cyangwa kuwutanga. Umurwayi wavuwe na nicardipine yahawe norepinephrine ariko ntiyagize ingaruka mbi ku gihe kirekire.
ubuyobozi. Amakosa akunze kugaragara arimo amakosa ku gipimo cyangwa ubwinshi bw'imiti, amakosa ku gipimo kitari cyo, n'ikosa ku muti. Amenshi muri aya makosa aterwa no gukora porogaramu idahwitse ya pompe y'amazi meza, kimwe mu biterwa no kuba hari uburyo bwo guhitamo dose mu bubiko bw'imiti, haba ku buremere cyangwa ntayo; amakosa yo kubika; guhuza no guhuza imiti yaciwe cyangwa yahagaritswe n'umurwayi watangiye kuyitera nabi cyangwa ntagaragaze imirongo kandi ntayikurikize igihe yatangiraga cyangwa yongeraga kuyitera. Hari ikintu cyagenze nabi mu byumba by'ubutabazi n'ibyumba byo kubaga, kandi pompe y'amazi meza ihuye n'inyandiko z'ubuzima bw'ikoranabuhanga (EHR) ntabwo yabonetse. Haravugwa kandi ko habayeho kwangirika kw'ingingo z'umubiri.
Umuforomo yatanze norepinephrine nk'uko byagenwe ku gipimo cya 0.1 µg/kg/min. Aho gushyiraho porogaramu yo gutanga 0.1 mcg/kg/min, umuforomo yashyizeho porogaramu yo gutanga 0.1 mcg/min. Kubera iyo mpamvu, umurwayi yahawe norepinephrine iri munsi y'inshuro 80 ugereranyije n'iyatanzwe. Ubwo infusion yashyirwaga buhoro buhoro ikagera ku gipimo cya 1.5 µg/min, umuforomo yasanze ageze ku gipimo ntarengwa cyagenwe cya 1.5 µg/kg/min. Kubera ko umuvuduko w'amaraso y'umurwayi utari usanzwe, hongeweho indi vasopressor.
Ibicuruzwa n'ububiko. Amakosa menshi agaragara iyo kuzuza utubati two gutanga imiti (ADCs) cyangwa guhindura utubati twa norepinephrine mu tugare twanditseho code. Impamvu nyamukuru y'aya makosa mu bubiko ni uko byanditseho kandi bigapfunyika. Ariko, hari izindi mpamvu zisanzwe zagaragaye, nko kuba hari urwego ruto rw'imiti ya norepinephrine muri ADC itari ihagije kugira ngo ihuze n'ibyo abarwayi bakeneye, bigatuma imiti itinda kuvurwa iyo farumasi zagombaga gukora inyigo kubera ibura ry'imiti. Kunanirwa gushakisha barcode ya buri gicuruzwa cya norepinephrine mu gihe cyo kubika ADC ni indi mpamvu ikunze gutera amakosa.
Umufarumasiye yujuje ADC umuti wa norepinephrine wa 32 mg/250 ml wateguwe na farumasi mu kabati ka 4 mg/250 ml premix k'uruganda. Umuforomo yahuye n'ikosa ubwo yageragezaga kwakira 4 mg/250 ml ya norepinephrine iva kuri ADC. Barcode kuri buri ruhushya rwo kwinjizwamo ntirwasuzumwe mbere yo gushyirwa muri ADC. Ubwo umuforomo yamenyaga ko hari agapfunyika ka 32 mg/250 ml gusa muri ADC (kagomba kuba mu gice gikonjeshwa cya ADC), yasabye ko haboneka ingano ikwiye. Imiti ya norepinephrine ya 4mg/250mL ntabwo iboneka muri farumasi bitewe n'uko uruganda rudafite paki za 4mg/250mL zavanzwe mbere, bigatuma habaho gutinda mu kuvanga imiti.
Gukurikirana abarwayi nabi, kugabanya umubare w'imiti iterwa na norepinephrine mu buryo butari bwo, no kudatekereza igihe ipaki ikurikira yo gutera imiti ni byo bintu bikunze gutera amakosa yo gukurikirana.
Umurwayi uri ku mpfiro yategetswe "kudakomeza kubyutsa umubiri" aterwa urushinge rwa norepinephrine kugira ngo rumufashe igihe gihagije kugira ngo umuryango we umusezere. Inyongera ya norepinephrine yararangiye, kandi nta gikapu cy'inyongera cyari kiri muri ADC. Umuforomo yahise ahamagara farumasi asaba igikapu gishya. Farumasi ntiyabonye umwanya wo gutegura umuti mbere yuko umurwayi apfa maze asezera ku muryango we.
Akaga. Ibyago byose bitagize ikosa bitangazwa kuri ISMP kandi birimo amazina asa cyangwa amazina y'imiti. Raporo nyinshi zigaragaza ko uburyo bwo gupakira no gushyiramo ibirango by'ingano zitandukanye za norepinephrine zitangwa n'abakozi ba 503B basa nkaho bisa.
Inama ku bijyanye no kwirinda indwara. Tekereza ku nama zikurikira mu gihe utegura cyangwa uvugurura ingamba z'ikigo cyawe zo kugabanya amakosa mu ikoreshwa ry'imiti ya norepinephrine (n'indi miti igabanya ubukana bw'imitsi):
Kugabanya uburemere bw'umuti. Bigenwa ku mubare muto w'ibipimo byo kuvura abana n'abarwayi bakuru. Garagaza uburemere ntarengwa bwo guterwa cyane bugenewe abarwayi bafite ikibazo cyo kugabanya amazi cyangwa bakeneye dose nyinshi za norepinephrine (kugira ngo bagabanye impinduka mu gikapu).
Hitamo uburyo bumwe bwo gutanga ingero. Shyiraho uburyo bwo gutanga ingero za norepinephrine hakurikijwe uburemere bw'umubiri (mcg/kg/min) cyangwa utari wo (mcg/min) kugira ngo ugabanye ibyago byo kwibeshya. Umuryango w’Abanyamerika w’Abafarumasiye b’Ubuzima (ASHP) Safety Standards Initiative4 utanga inama yo gukoresha ibipimo bya norepinephrine muri mikorogarama/kg/umunota. Hari ibitaro bishobora gushyiraho ibipimo bingana na mikorogarama ku munota bitewe n’ibyo muganga akunda - byombi byemewe, ariko uburyo bubiri bwo gutanga ingero ntibwemewe.
Bisaba guhabwa imiti hakurikijwe icyitegererezo gisanzwe cyo gutondeka. Bisaba imiti ikoreshwa mu gutera norepinephrine hakoreshejwe icyitegererezo gisanzwe cyo gutondeka gifite imirima ikenewe kugira ngo umuntu agere ku rugero runaka, intego ipimwa yo gutondeka (urugero, SBP, umuvuduko w'amaraso wa systolic), ibipimo bya titration (urugero, urugero, igipimo cyo gutangira, urugero rw'ingano, icyiciro cyo kongera, n'inshuro yo kuyitanga) hejuru cyangwa hasi), inzira yo kuyitanga n'igipimo ntarengwa kitagomba kurengwa cyangwa/cyangwa umuganga uhari agomba guhamagara. Igihe gisanzwe cyo gusoza imiti kigomba kuba "stat" kugira ngo izi miti zijye imbere mu murongo wa farumasi.
Imipaka y'amabwiriza yo mu magambo. Imipaka y'amabwiriza yo mu magambo ku bibazo byihutirwa cyangwa iyo umuganga adashobora kwinjira cyangwa kwandika itegeko hakoreshejwe ikoranabuhanga. Abaganga bagomba kwishyiriraho gahunda zabo keretse hari impamvu zumvikana.
Gura imiti yakozwe mu gihe ihari. Koresha ingano y'imiti ya norepinephrine ivanze mbere iva mu nganda cyangwa imiti yateguwe n'abacuruzi b'abandi (nk'urugero 503B) kugira ngo ugabanye igihe cyo gutegura imiti muri farumasi, ugabanye gutinda kuvurwa, kandi wirinde amakosa yo gukora imiti muri farumasi.
Gutandukanya ingano zitandukanye z'umuti mbere yo kuwutanga.
Tanga urugero ruhagije rw'igipimo cya ADC. Ongera ugure ADC kandi utange imiti ihagije ya norepinephrine kugira ngo ihuze n'ibyo umurwayi akeneye. Reba uko ikoreshwa kandi uhindure urugero rusanzwe uko bikenewe.
Gushyiraho inzira zo gutunganya ibintu mu byiciro cyangwa kongera umusaruro uko bikenewe. Kubera ko bishobora gufata igihe kugira ngo habeho kuvanga ingano ntarengwa itarasubizwa, farumasi zishobora gukoresha ingamba zitandukanye zo gushyira imbere gutegura no gutanga ibicuruzwa ku gihe, harimo no kubipima no kubikanda iyo ibikoresho birimo ubusa mu masaha make, bitewe n'aho bita ku bitaro cyangwa ubutumwa bwo kuri imeri bugomba gutegurwa.
Buri gapaki/agacupa karasuzumwa. Kugira ngo hirindwe amakosa mu gihe cyo gutegura, gukwirakwiza, cyangwa kubika, skana barcode kuri buri gakapu cyangwa agacupa ka norepinephrine kugira ngo ugenzure mbere yo gutegura, gukwirakwiza, cyangwa kubika muri ADC. Barcode zishobora gukoreshwa gusa ku birango bishyirwa ku gacupa.
Reba icyapa kiri ku gakapu. Niba agakapu gafunga gato gakoreshwa mu gihe cyo gusuzuma ikoreshwa ryako, umuti wa norepinephrine ugomba gukurwa mu gakapu by'agateganyo kugira ngo upimwe. Ubundi buryo, shyira agakapu gakingira gato hejuru y'umuti mbere yo gupimwa hanyuma ugashyire mu gakapu ako kanya nyuma yo gupimwa.
Shyiraho amabwiriza. Shyiraho amabwiriza (cyangwa protocole) yo gutera norepinephrine (cyangwa indi miti ifite titration), harimo ibipimo bisanzwe, urugero rw'ingano itekanye, kwiyongera kw'ingano isanzwe, inshuro zo gutera (iminota), urugero ntarengwa/igipimo, ibanze, hamwe n'igenzura rikenewe. Niba bishoboka, huza inama n'umurongo wo gutera mu gitabo cy'imiti (MAR).
Koresha pompe ikoresha ubwenge. Inyongera zose za norepinephrine zishyirwamo kandi zigashyirwamo titration hakoreshejwe pompe ikoresha ubwenge ifite sisitemu yo kugabanya amakosa y’umuti (DERS) kugira ngo DERS ibashe kumenyesha abaganga amakosa ashobora guterwa, kubara, cyangwa porogaramu.
Koresha uburyo bwo guhuza. Aho bishoboka, koresha pompe y'ikoranabuhanga ikoresha ikoranabuhanga rigezweho kandi rijyanye n'amakuru y'ubuzima bw'ikoranabuhanga. Uburyo bwo gukorana butuma pompe zuzura mbere na muganga (nibura mu ntangiriro yo gukoresha titration) kandi byongera ubumenyi mu by'imiti ku gipimo cy'ibisigaye mu miti ikoreshwa titrated.
Shyira akamenyetso ku mirongo hanyuma ushyireho umurongo ku miyoboro. Shyira akamenyetso kuri buri murongo w’imiti hejuru y’ipompo no hafi y’aho umurwayi yinjira. Byongeye kandi, mbere yo gutangira cyangwa guhindura agafuka ka norepinephrine cyangwa igipimo cyo kuyitera, shyira umuyoboro mu ntoki uhereye ku gikoresho cy’umuti ujya ku ipompo n’umurwayi kugira ngo urebe neza ko ipompo/umuyoboro n’inzira yo kuyitera ari byo.
Emera isuzuma. Iyo umuti mushya uhagaritswe, hakenewe isuzuma rya tekiniki (urugero: barcode) kugira ngo harebwe niba umuti/umuti uhuye, ingano y'umuti n'umurwayi ari muke.
Hagarika guterwa umuti. Niba umurwayi ameze neza mu masaha 2 nyuma yo guhagarika guterwa umuti wa norepinephrine, tekereza ku muganga umuvura itegeko ryo guhagarika guterwa umuti. Iyo guterwa umuti uhagaritswe, hita ukuramo umuti uvanywe mu murwayi, uwukure mu ipompo, hanyuma uwujugunye kugira ngo wirinde ko umunwa utangwa ku bw'impanuka. Umuti uvanywe mu murwayi ugomba kandi gukurwa mu murwayi niba umuti uhagaritswe mu gihe kirenze amasaha 2.
Shyiraho uburyo bwo gusohora imisemburo. Shyiraho uburyo bwo gusohora imisemburo yo gusohora imisemburo ya norepinephrine. Abaforomo bagomba kumenyeshwa iyi gahunda, harimo no kuvura na phentolamine mesylate no kwirinda gukonjesha agace kafashwe n'indwara, bishobora kongera kwangirika kw'ingingo.
Suzuma uburyo bwo gupima umuvuduko w'amaraso. Genzura uko abakozi bubahiriza amabwiriza yo gutera norepinephrine, amabwiriza n'amabwiriza yihariye ya muganga, ndetse n'ibyavuye mu murwayi. Ingero z'ibipimo zirimo kubahiriza ibipimo bya titration bisabwa kuri gahunda; gutinda kuvurwa; gukoresha pompe za smart hamwe na DERS (n'uburyo bwo gukorana); gutangira gutera umuti ku gipimo cyagenwe; titration hakurikijwe inshuro zagenwe n'ibipimo bya dosing; pompe ya smart ikwereka inshuro n'ubwoko bw'igipimo, inyandiko z'ibipimo bya titration (bigomba guhuza n'impinduka z'igipimo) n'ingaruka z'umurwayi mu gihe cyo kuvurwa.