The Ottawa Hospital, Associate Scientist, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
Ann Pharmacother. 2013 May;47(5):637-43. doi: 10.1345/aph.1R414. Epub 2013 Apr 19.
Critically ill patients often receive multiple medications via continuous intravenous infusion. Coadministration of multiple medications through the same port of a venous access device often is necessary but requires an assessment of compatibility.
To describe the frequency of inappropriate coadministration of continuously infused medications via a Y-site and the use of intravenous catheters in patients in Canadian intensive care units (ICUs) in a multicenter, cross-sectional observational study.
Data pertaining to medication compatibility via Y-site infusion (medication combinations known to be incompatible or not known to be compatible), frequency of specific medications administered via continuous infusion, and catheter use (median number, location, and types of venous catheters) were collected from medical records of 434 patients in the ICUs of 13 teaching hospitals in Canada.
Forty-six percent of patients were receiving 2 or more medication infusions simultaneously. Forty episodes of inappropriate coadministration of these infusions were identified in 37 patients. The prevalence of inappropriate coadministration of drugs via a Y-site port in all patients was 8.5% (95% CI 5.8-11.2). The prevalence of incompatible combinations via Y-site in patients with 2 or more medication infusions was 18.7%. Twenty-five of these 37 patients could have had their drug schedules rearranged into acceptable combinations, leaving 12 patients who would have required additional intravenous access to facilitate appropriate medication infusions. Median (range) number of central and peripheral venous access devices inserted per patient were 1 (0-4) and 1 (0-5), respectively. Seventeen of 95 patients with 2 or more central venous catheters could have had their medication infusions rearranged to render 1 catheter idle.
Inappropriate Y-site combinations of medications continuously infused in Canadian ICUs are common. Management of medication infusions could, however, have been optimized in most of these situations.
危重症患者常通过持续静脉输注接受多种药物治疗。为了达到治疗效果，通常需要通过静脉通路装置的同一端口同时输注多种药物，但这需要评估药物的相容性。
在一项多中心、横断面观察性研究中，描述加拿大重症监护病房（ICU）中连续输注药物通过 Y 型管不合理联合给药的频率以及静脉导管的使用情况。
从加拿大 13 所教学医院的 ICU 中 434 名患者的病历中收集有关 Y 型管输注药物相容性的数据（已知不相容或未知相容的药物组合）、通过连续输注给予的特定药物的频率以及导管使用情况（中心静脉导管和外周静脉导管的中位数数量、位置和类型）。
46%的患者同时接受 2 种或更多种药物输注。在 37 名患者中发现了 40 例这些输注不合理联合用药的情况。所有患者 Y 型管端口不合理联合用药的发生率为 8.5%（95%CI 5.8%-11.2%）。同时接受 2 种或更多种药物输注的患者中，通过 Y 型管进行的药物联合不合理的发生率为 18.7%。这 37 名患者中有 25 名可以将药物方案重新安排为可接受的组合，而 12 名患者则需要额外的静脉通路来进行适当的药物输注。每位患者中位数（范围）插入的中心和外周静脉通路装置数量分别为 1（0-4）和 1（0-5）。在 95 名接受 2 种或更多中央静脉导管的患者中，有 17 名患者可以调整其药物输注方案，使 1 个导管闲置。
在加拿大的 ICU 中，连续输注药物时 Y 型管不合理联合用药的情况很常见。然而，在大多数情况下，这些情况都可以通过优化药物输注管理来解决。
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