Amakuru

Ikibazo: Norepinephrine numuti uboneka cyane utangwa mumitsi (IV) nkumuti uhoraho. Ni vasopressor ikunze kwitirirwa kugira ngo igumane umuvuduko uhagije wamaraso hamwe no gutera urugingo kubantu bakuze barembye cyane ndetse nabana bafite hypotension cyangwa ihungabana rikomeje nubwo amazi ya rehidrasi ihagije. Ndetse amakosa mato muri titre cyangwa dose, kimwe no gutinda kwivuza, bishobora gutera ingaruka mbi. Sisitemu yubuzima ya Multicenter iherutse kohereza ISMP ibisubizo by’isesengura rusange (CCA) ku makosa 106 ya norepinephrine yabaye muri 2020 na 2021. Gucukumbura ibintu byinshi hamwe na CCA bituma amashyirahamwe akusanya imizi rusange hamwe n’intege nke za sisitemu. Amakuru yo muri gahunda yo gutanga raporo yumuryango hamwe na pompe yubwenge yakoreshejwe kugirango hamenyekane amakosa ashobora kuba.
ISMP yakiriye raporo 16 zijyanye na noradrenaline muri 2020 na 2021 binyuze muri gahunda yo gutanga raporo ku makosa y’imiti ya ISMP (ISMP MERP). Hafi ya kimwe cya gatatu cya raporo zerekeranye n’akaga kajyanye n’amazina, ibirango, cyangwa gupakira, ariko nta makosa yagaragaye. Twasohoye raporo y’amakosa arindwi ya norepinephrine: amakosa ane yo kunywa (16 Mata 2020; 26 Kanama 2021; 24 Gashyantare 2022); ikosa rimwe ryo kwibanda ku buryo butari bwo; ikosa rimwe ryo kwitirirwa nabi ibiyobyabwenge; guhagarika impanuka ya norepinephrine. Raporo zose uko ari 16 ISMP zongerewe muri sisitemu yubuzima ya CCA (n = 106) kandi ibisubizo byahurijwe hamwe (N = 122) kuri buri ntambwe mugikorwa cyo gukoresha ibiyobyabwenge byerekanwe hano hepfo. Ikosa ryatangajwe ririmo gutanga urugero rwimpamvu zimwe zisanzwe.
Andika. Twabonye ibintu byinshi bitera bifitanye isano no kwandika amakosa, harimo gukoresha bidakenewe amategeko yo mu kanwa, kwandika norepinephrine udakoresheje amabwiriza, hamwe n'intego zidasobanutse neza cyangwa zidashidikanywaho hamwe na / cyangwa ibipimo byerekana (cyane cyane niba amabwiriza adakoreshwa). Rimwe na rimwe, ibipimo byateganijwe byitirirwa birakomeye cyangwa bidashoboka (urugero, kwiyongera byateganijwe ni binini cyane), bigatuma abaforomo bigora kubahiriza mugihe bakurikirana umuvuduko wamaraso wumurwayi. Mu bindi bihe, abaganga barashobora kugena ibipimo bishingiye ku buremere cyangwa bidafite uburemere, ariko ibi rimwe na rimwe bitiranya. Ibi hanze-y-agasanduku byandika byongera amahirwe yo kuba abaganga bo hasi bakora amakosa, harimo namakosa yo gutangiza pompe, kubera ko amahitamo abiri yo kuboneka aboneka mumasomero ya pompe. Byongeye kandi, byatinze byavuzwe ko bisaba gutondekanya ibyateganijwe mugihe amabwiriza yatanzwe harimo amabwiriza ashingiye ku buremere kandi adashingiye ku buremere.
Muganga arasaba umuforomo kwandika urupapuro rwa norepinephrine kumurwayi ufite umuvuduko ukabije wamaraso. Umuforomokazi yinjiye muri gahunda nkuko umuganga yabitegetse mu magambo: 0,05 mcg / kg / min IV yitiriwe intego bisobanura umuvuduko wa arterial (MAP) hejuru ya 65 mmHg. Ariko amabwiriza ya dosiye ya muganga avanga urugero rwinshi rudasanzwe rwibipimo hamwe nuburemere ntarengwa bushingiye ku buremere: titrate ku gipimo cya 5 mcg / min buri minota 5 kugeza ku kigero kinini cya 1.5 mcg / kg / min. Ishyirahamwe ryubwenge bwa infusion pompe ntirwashoboye gutanga titre ya mcg / min kugeza ku gipimo ntarengwa gishingiye ku buremere, mcg / kg / min. Abafarumasiye bagombaga gusuzuma amabwiriza n'abaganga, bigatuma batinda kwivuza.
Tegura kandi ukwirakwize. Amakosa menshi yo kwitegura no kuyaterwa biterwa numurimo ukabije wa farumasi, wongerewe nabakozi ba farumasi bisaba kwinjiza cyane norepinephrine (32 mg / 250 ml) (iboneka kuri farumasi ya 503B ariko ntibiboneka ahantu hose). biganisha kuri multitasking n'umunaniro. Izindi mpamvu zikunze gutera amakosa yo gutanga harimo ibirango bya noradrenaline byihishe mumifuka ifatanye urumuri no kutumva kwabakozi ba farumasi byihutirwa gutanga.
Kwishyira hamwe kwa norepinephrine na nicardipine mumufuka wijimye wijimye byagenze nabi. Kubirindiro byijimye, sisitemu yo gukuramo yacapye ibirango bibiri, kimwe kumufuka winjizamo ubwacyo ikindi hanze yumufuka wa amber. Indwara ya Norepinephrine yashyizwe mubushake bwa paki ya amber yanditseho "nicardipine" mbere yo gukwirakwiza ibicuruzwa kugirango bikoreshe abarwayi batandukanye naho ubundi. Amakosa ntiyagaragaye mbere yo gutanga cyangwa kunywa. Umurwayi wavuwe na nicardipine yahawe norepinephrine ariko ntabwo yangije igihe kirekire.
ubuyobozi. Amakosa asanzwe arimo ikosa cyangwa ikosa ryibanze, ikosa ryibipimo bitari byo, nibiyobyabwenge bitari byo. Amenshi muri ayo makosa aterwa na progaramu itari yo ya pompe yubwenge ya infusion, igice bitewe nuko habayeho guhitamo dose mubitabo byibiyobyabwenge, haba muburemere kandi bitarimo; amakosa yo kubika; guhuza no guhuza infashanyo zahagaritswe cyangwa zahagaritswe kumurwayi zatangiye kwinjiza nabi cyangwa ntizashyizeho umurongo kandi ntizikurikize mugihe utangiye cyangwa wongeye gushya. Ikintu kitagenze neza mubyumba byihutirwa no mubyumba byo gukoreramo, kandi guhuza pompe yubwenge hamwe nubuzima bwa elegitoroniki (EHR) ntibyaboneka. Kurenza urugero biganisha ku kwangirika kwinyama nabyo byavuzwe.
Umuforomokazi yatanze norepinephrine nkuko byerekanwa ku gipimo cya 0.1 µg / kg / min. Aho gutunganya pompe kugirango itange 0.1 mcg / kg / min, umuforomo yateguye pompe gutanga 0.1 mcg / min. Kubera iyo mpamvu, umurwayi yakiriye norepinephrine inshuro 80 kurenza uko byateganijwe. Iyo infusion yagiye yitirirwa buhoro buhoro ikagera ku gipimo cya 1.5 µg / min, umuforomo yemeje ko yageze ku gipimo ntarengwa cyagenwe cya 1.5 µg / kg / min. Kuberako umuvuduko wumurwayi wa arterial wari ukiri udasanzwe, hiyongereyeho vasopressor ya kabiri.
Ibarura nububiko. Amakosa menshi abaho mugihe yuzuza akabati yatanzwe (ADCs) cyangwa guhindura inzabya za norepinephrine mumagare yanditse. Impamvu nyamukuru yaya makosa yibaruramari ni ikimenyetso kimwe no gupakira. Icyakora, izindi mpamvu zikunze kugaragara nazo zagaragaye, nk'urwego ruto rwo kwanduza norepinephrine muri ADC rudahagije kugira ngo rushobore gukenera ishami rishinzwe ubuvuzi bw'abarwayi, bigatuma ubuvuzi butinda niba farumasi zigomba gukora infusion kubera kubura. Kunanirwa gusikana barcode ya buri gicuruzwa cya norepinephrine mugihe ubitse ADC nindi soko isanzwe yamakosa.
Umufarumasiye yibeshye yuzuza ADC hamwe na farumasi yateguwe na mg / 250 ml norepinephrine yumuti wa 4 mg / 250 ml. Umuforomokazi yahuye n'ikosa mugihe yagerageje kwakira mg / 250 ml norepinephrine yatewe na ADC. Barcode kuri buri muntu ku giti cye ntiyigeze isikanwa mbere yo gushyirwa muri ADC. Umuforomokazi amaze kubona ko muri ADC harimo 32 mg / 250 ml gusa (igomba kuba mu gice gikonjesha cya ADC), yasabye ko byakwitabwaho neza. Norepinephrine 4mg / 250mL ibisubizo byokuboneka ntibiboneka muri farumasi kubera ko uruganda rwabuze udupfunyika twa 4mg / 250mL, bigatuma habaho gutinda kuvanga infusion infusion.
gukurikirana. Gukurikirana nabi abarwayi, titre ya norepinephrine yatewe hanze y'ibipimo byateganijwe, kandi ntutegereze igihe igikapu gikurikiraho gikenewe nimpamvu zikunze gutera amakosa yo gukurikirana.
Umurwayi uri hafi gupfa afite itegeko ryo "kutongera kuzura" yatewe na norepinephrine kumara igihe kirekire bihagije kugirango umuryango we usezere. Kwinjiza norepinephrine byarangiye, kandi muri ADC nta mufuka wabigenewe. Umuforomokazi yahise ahamagara farumasi asaba igikapu gishya. Farumasi ntiyabonye umwanya wo gutegura imiti mbere yuko umurwayi apfa asezera ku muryango we.
Akaga. Ibyago byose bitavuyemo amakosa biramenyeshwa ISMP kandi birimo ibimenyetso bisa cyangwa amazina yibiyobyabwenge. Raporo nyinshi zerekana ko gupakira no gushyiramo ibimenyetso bitandukanye byatewe na norepinephrine yatanzwe na 503B bo hanze basa nkaho ari kimwe.
Ibyifuzo byo kwitoza neza. Reba ibyifuzo bikurikira mugihe utegura cyangwa uvugurura ingamba zikigo cyawe kugirango ugabanye amakosa mugukoresha neza ikoreshwa rya norepinephrine (nizindi vasopressor):
kugabanya kwibanda. Bisanzwe kumubare ntarengwa wo kwibanda kubuvuzi bwabana na / cyangwa abarwayi bakuze. Kugaragaza imipaka yuburemere bwokwibanda cyane kubikwa kubarwayi bafite amazi yabujijwe cyangwa bisaba urugero rwinshi rwa norepinephrine (kugirango uhindure imifuka).
Hitamo uburyo bumwe. Kuringaniza imiti ya norepinephrine nkuko ushingiye kuburemere bw'umubiri (mcg / kg / min) cyangwa utayifite (mcg / min) kugirango ugabanye ibyago byo kwibeshya. Umuryango w’Abanyamerika w’ubuzima bwa Farumasi (ASHP) Ubuziranenge bw’umutekano4 urasaba ko hakoreshwa ibipimo bya norepinephrine muri micrograms / kg / umunota. Ibitaro bimwe birashobora kugereranya urugero rwa microgramu kumunota bitewe nibyifuzo bya muganga - byombi biremewe, ariko uburyo bubiri bwo kunywa ntibyemewe.
Irasaba kwandika ukurikije icyitegererezo gisanzwe. Irasaba imiti ya norepinephrine ukoresheje icyitegererezo gisanzwe cyo gutondekanya hamwe nimirima isabwa kugirango ushishikarire kwibandaho, intego yo gupima titre (urugero, SBP, umuvuduko wamaraso wa systolique), ibipimo byerekana (urugero, gutangira ibipimo, urugero rwinshi, igice cyo kwiyongera, hamwe ninshuro yo kwiyongera) hejuru cyangwa hepfo), inzira yubuyobozi nigipimo ntarengwa kitagomba kurenga kandi / cyangwa umuganga witabye agomba guhamagarwa. Igihe ntarengwa cyo guhinduka kigomba kuba "stat" kugirango aya mabwiriza afate umwanya wa mbere muri farumasi.
Gabanya amategeko mu magambo. Gabanya amabwiriza mu magambo byihutirwa cyangwa mugihe muganga adashoboye kwinjira cyangwa kwandika itegeko kuri elegitoroniki. Abaganga bagomba kwishyiriraho gahunda keretse habaye impamvu nyoroshyacyaha.
Gura ibisubizo byiteguye mugihe biboneka. Koresha uburyo bwibanze bwibisubizo bya norepinephrine biva mubakora na / cyangwa ibisubizo byateguwe nabacuruzi ba gatatu (nka 503B) kugirango ugabanye igihe cyo gutegura farumasi, kugabanya gutinda kwivuza, kandi wirinde amakosa yo gukora farumasi.
kwibanda ku buryo butandukanye. Tandukanya ibitekerezo bitandukanye ubikora muburyo butandukanye mbere yo kunywa.
Tanga urwego ruhagije rwa ADC. Wibike kuri ADC kandi utange norepinephrine ihagije kugirango uhuze abarwayi. Kurikirana imikoreshereze no guhindura urwego rusanzwe nkuko bikenewe.
Kora inzira zo gutunganya ibyiciro na / cyangwa guhuza kubisabwa. Kuberako bishobora gufata igihe cyo kuvanga intumbero ntarengwa itemewe, farumasi irashobora gukoresha ingamba zitandukanye kugirango ishyire imbere gutegura no kuyitanga mugihe gikwiye, harimo kunywa no / cyangwa kwikuramo mugihe kontineri irimo ubusa mumasaha, biterwa nokwitaho cyangwa kumenyesha imeri bigomba kuba byateguwe.
Buri paki / vial irasikanwa. Kugira ngo wirinde amakosa mugihe cyo gutegura, gukwirakwiza, cyangwa kubika, suzuma kode kuri buri mufuka wa norepinephrine cyangwa vial kugirango ugenzure mbere yo gutegura, gukwirakwiza, cyangwa kubika muri ADC. Barcode irashobora gukoreshwa gusa kubirango byometse kuri paki.
Reba ikirango ku mufuka. Niba umufuka ufashe urumuri ukoreshwa mugihe cyo kugenzura bisanzwe, kwinjiza norepinephrine bigomba kuvanwa mugihe gito mumufuka kugirango bipimishe. Ubundi, shyira umufuka urinda urumuri mbere yo kwipimisha hanyuma ubishyire mumufuka ako kanya nyuma yo kwipimisha.
Shiraho umurongo ngenderwaho. Shiraho umurongo ngenderwaho (cyangwa protocole) kugirango ushiremo titre ya norepinephrine (cyangwa indi miti yitiriwe titre), harimo kwibanda ku bisanzwe, urugero rwiza rwuzuye, kwiyongera kwa titre dose, inshuro nyinshi (iminota), igipimo ntarengwa / igipimo, ibipimo fatizo, hamwe no gukurikirana bisabwa. Niba bishoboka, ihuza ibyifuzo na titre de titre muri Medicare Regulatory Record (MAR).
Koresha pompe yubwenge. Indwara zose za norepinephrine zinjizwamo kandi zitwa titre ukoresheje pompe yubwenge ifite ubwenge hamwe na Dose Error Reduction Sisitemu (DERS) ishoboye kugirango DERS ibashe kumenyesha inzobere mubuzima kubishobora kwandika, kubara, cyangwa porogaramu.
Gushoboza guhuza. Aho bishoboka, fasha pompe ya-icyerekezo cyubwenge bwa infusion pomp ijyanye nibyuma byubuzima bwa elegitoroniki. Imikoranire ituma pompe zuzuzwa hamwe na verisiyo zagenzuwe zashyizweho na muganga (byibuze mugitangira titre) kandi bikongerera farumasi kumenya umubare usigaye muri infusion.
Shyira kumurongo hanyuma ukurikirane imiyoboro. Shyira akamenyetso kuri buri murongo hejuru ya pompe no hafi yumurwayi. Byongeye kandi, mbere yo gutangira cyangwa guhindura umufuka wa norepinephrine cyangwa igipimo cyo gushiramo, koresha intoki unyuze mu cyombo gikemurwa kugeza kuri pompe n’umurwayi kugira ngo umenye neza ko pompe / umuyoboro n'inzira z'ubuyobozi ari byo.
Emera ubugenzuzi. Iyo infusion nshya ihagaritswe, hasabwa ubugenzuzi bwa tekiniki (urugero: barcode) kugirango hamenyekane ibiyobyabwenge / igisubizo, ibiyobyabwenge hamwe n’umurwayi.
Hagarika gushiramo. Niba umurwayi atuje mugihe cyamasaha 2 nyuma yo guhagarika kwinjiza norepinephrine, tekereza kubona icyemezo cyo guhagarika umuganga uvura. Iyo infusion imaze guhagarikwa, hita uhagarika umurwayi umurwayi, uyikure kuri pompe, hanyuma ujugunye kugirango wirinde ubuyobozi bwimpanuka. Kwinjiza bigomba kandi guhagarikwa kumurwayi niba infusion ihagaritswe amasaha arenze 2.
Shiraho protocole idasanzwe. Shiraho protocole yo gukabya kugirango ugabanye norepinephrine. Abaforomo bagomba kumenyeshwa ibijyanye nubu buryo, harimo kuvura hamwe na mesylate ya fenolamine no kwirinda compresses ikonje ahantu hafashwe, bishobora kongera kwangirika kwinyama.
Suzuma imyitozo yitirirwa. Kurikirana abakozi kubahiriza ibyifuzo byo kwinjiza norepinephrine, protocole hamwe nubuvuzi bwihariye bwa muganga, hamwe nibisubizo byabarwayi. Ingero zingamba zirimo kubahiriza ibipimo bya titre bisabwa kurutonde; gutinda kwivuza; gukoresha pompe zubwenge hamwe na DERS ishoboye (na interoperability); tangira gushiramo ku gipimo cyagenwe; titre ukurikije inshuro zagenwe hamwe nibipimo byo kugabanya; pompe yubwenge irakumenyesha inshuro nubwoko bwa dose, inyandiko zerekana ibipimo bya titre (bigomba guhura nimpinduka zifatika) nibibi byabarwayi mugihe cyo kuvura.