Department of Pharmacy, The Hospital for Sick Children, Toronto, Ontario, Canada.
Pharmacotherapy. 2011 Aug;31(8):776-84. doi: 10.1592/phco.31.8.776.
To evaluate the extent of agreement between plasma gentamicin concentrations determined from samples collected by using implantable subcutaneous central venous catheters (ports) with the push-pull method and those collected by finger lancet punctures in children with febrile neutropenia.
Prospective, randomized study.
University-affiliated, tertiary care hospital.
Sixty-two children with cancer who had single- or double-lumen ports and who received gentamicin for treatment of febrile neutropenia between February 2008 and October 2009.
One blood sample was collected from the port by using the push-pull method at the same time one blood sample was collected by finger lancet puncture for determination of plasma gentamicin concentrations.
Forty-four pairs of samples were available for assessment of agreement, and 43 were available for pharmacokinetic analysis. Agreement between plasma gentamicin concentrations determined from blood samples from ports and finger lancet punctures was assessed by the intraclass correlation coefficient (ICC), Bland-Altman analysis, and comparison of simulated dosage adjustments. Changes in port patency were monitored for 1 week after port sampling. Differences in simulated dosage adjustments calculated by using either the port or finger lancet puncture samples that differed by greater than 20% were considered clinically significant. Agreement between the 44 finger lancet puncture and port sample pairs was excellent (ICC 0.991, 95% confidence interval 0.984-0.995). Port plasma gentamicin concentrations were 4.7% lower than those concentrations determined in blood from finger lancet punctures. The observed limits of agreement ranged from -20.5% to 11%. Differences in dosage adjustments calculated by using port and finger lancet puncture plasma gentamicin concentrations were not clinically significant in 38 (88%) of 43 cases. No changes in port patency were observed in the week after port sampling.
The push-pull method of blood sampling is a reliable and safe option for determining plasma gentamicin concentrations in children with ports.
评估使用植入式皮下中心静脉导管（端口）推-拉法采集的血浆庆大霉素浓度与通过手指刺血采集的血浆庆大霉素浓度在发热性中性粒细胞减少症患儿中的一致性程度。
前瞻性、随机研究。
大学附属的三级保健医院。
2008 年 2 月至 2009 年 10 月期间患有癌症且使用庆大霉素治疗发热性中性粒细胞减少症的 62 名具有单腔或双腔端口的儿童。
使用推-拉法从端口采集一份血样，同时通过手指刺血采集一份血样以测定血浆庆大霉素浓度。
有 44 对样本可用于评估一致性，有 43 对样本可用于药代动力学分析。通过组内相关系数（ICC）、Bland-Altman 分析和模拟剂量调整比较评估从端口和手指刺血采集的血样中测定的血浆庆大霉素浓度之间的一致性。在端口采样后 1 周监测端口通畅性的变化。通过使用端口或手指刺血采集的样本计算的模拟剂量调整差异大于 20%被认为具有临床意义。44 对手指刺血和端口样本之间的一致性非常好（ICC 0.991，95%置信区间 0.984-0.995）。端口血浆庆大霉素浓度比手指刺血样本低 4.7%。观察到的一致性范围为-20.5%至 11%。在 43 例中的 38 例（88%）中，通过使用端口和手指刺血采集的血浆庆大霉素浓度计算的剂量调整差异无临床意义。在端口采样后的一周内，未观察到端口通畅性的变化。
使用推-拉法采集血样是一种可靠且安全的方法，可用于确定具有端口的儿童的血浆庆大霉素浓度。
