Department of Biopharmacy, Galenic and Hospital Pharmacy, Université Lille Nord de France, Lille.
Anesth Analg. 2013 Jan;116(1):101-6. doi: 10.1213/ANE.0b013e31826f5e02. Epub 2012 Dec 7.
Drug incompatibility is a problem, especially when managing patients in intensive care units. We designed the present study to assess the impact of multilumen infusion access devices on the occurrence of known physical drug incompatibility through a controlled in vitro study.
Three infusion devices connected to a single-lumen catheter were studied: a standard set with 2-port manifold and 1-m extension set and 2 multilumen infusion access devices: a 3-lumen extension set and a 9-lumen extension set (Edelvaiss-Multiline™; Doran International, Toussieu, France). For the 9-lumen extension set, 3 infusion access combinations were studied. Furosemide, midazolam, and saline were infused simultaneously through 3 infusion devices. Three concentrations of furosemide were tested. The infusion rate of saline (carrier) was initially set at 100 mL/h and stepwise decreased by 10 mL/h until precipitate formation. Physical incompatibility was assessed by 2 tests: visual inspection and the subvisible particle count test according to the European Pharmacopeia. The lowest saline infusion rate to prevent visible precipitate and attain an acceptable particle count (i.e., to pass "the 2 tests") was reported for each infusion set.
The standard set revealed visible precipitate even at the highest saline flow rate (100 mL/h). The 3-lumen device prevented drug precipitation using the 2 lowest furosemide concentrations with a saline infusion rate that decreased with furosemide concentration. The 9-lumen infusion access device prevented drug precipitation whatever the furosemide concentration for 2 access combinations using saline infusion rates of between 20 and 60 mL/h but not for a third access combination, despite saline infusion rates equal to 100 mL/h.
Infusion device characteristics appear to have an impact on the physical compatibility of the 2 drugs. Under specified conditions, the 9-lumen infusion access device prevents physical furosemide-midazolam incompatibility.
药物不相容是一个问题，尤其是在重症监护病房管理患者时。我们设计了本项研究，以通过对照体外研究评估多腔输注装置对已知物理药物不相容发生的影响。
研究了连接至单腔导管的 3 种输注装置：带有 2 端口歧管和 1 米延长套件的标准套件和 2 种多腔输注接入装置：3 腔延长套件和 9 腔延长套件（Edelvaiss-MultilineTM；Doran International，Toussieu，法国）。对于 9 腔延长套件，研究了 3 种输注接入组合。呋塞米、咪达唑仑和生理盐水同时通过 3 种输注装置输注。测试了 3 种呋塞米浓度。生理盐水（载体）的初始输注速率设定为 100 mL/h，并以 10 mL/h 的步长逐渐降低，直至形成沉淀。通过 2 种测试评估物理不相容性：目测和根据欧洲药典的亚可见颗粒计数测试。对于每个输注套件，报告了预防可见沉淀并达到可接受的颗粒计数（即通过“2 种测试”）的最低生理盐水输注速率。
标准套件即使在最高生理盐水流速（100 mL/h）下也显示出可见沉淀。3 腔装置使用最低的 2 种呋塞米浓度和随着呋塞米浓度降低的生理盐水流速防止药物沉淀。9 腔输注接入装置无论呋塞米浓度如何，对于 2 种接入组合都能防止药物沉淀，生理盐水流速在 20 至 60 mL/h 之间，但对于第 3 种接入组合则不能，尽管生理盐水流速等于 100 mL/h。
输注装置特性似乎对 2 种药物的物理相容性有影响。在特定条件下，9 腔输注接入装置可防止物理呋塞米-咪达唑仑不相容。
