From the *Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University Medical Center, Stanford, California; †Department of Statistics, Stanford University, Stanford, California; and ‡Division of Biomaterials and Advanced Drug Delivery, Stanford University Medical Center, Stanford, California.
Anesth Analg. 2017 Oct;125(4):1192-1199. doi: 10.1213/ANE.0000000000001976.
In the perioperative period, anesthesiologists and postanesthesia care unit (PACU) nurses routinely prepare and administer small-volume IV injections, yet the accuracy of delivered medication volumes in this setting has not been described. In this ex vivo study, we sought to characterize the degree to which small-volume injections (≤0.5 mL) deviated from the intended injection volumes among a group of pediatric anesthesiologists and pediatric postanesthesia care unit (PACU) nurses. We hypothesized that as the intended injection volumes decreased, the deviation from those intended injection volumes would increase.
Ten attending pediatric anesthesiologists and 10 pediatric PACU nurses each performed a series of 10 injections into a simulated patient IV setup. Practitioners used separate 1-mL tuberculin syringes with removable 18-gauge needles (Becton-Dickinson & Company, Franklin Lakes, NJ) to aspirate 5 different volumes (0.025, 0.05, 0.1, 0.25, and 0.5 mL) of 0.25 mM Lucifer Yellow (LY) fluorescent dye constituted in saline (Sigma Aldrich, St. Louis, MO) from a rubber-stoppered vial. Each participant then injected the specified volume of LY fluorescent dye via a 3-way stopcock into IV tubing with free-flowing 0.9% sodium chloride (10 mL/min). The injected volume of LY fluorescent dye and 0.9% sodium chloride then drained into a collection vial for laboratory analysis. Microplate fluorescence wavelength detection (Infinite M1000; Tecan, Mannedorf, Switzerland) was used to measure the fluorescence of the collected fluid. Administered injection volumes were calculated based on the fluorescence of the collected fluid using a calibration curve of known LY volumes and associated fluorescence.To determine whether deviation of the administered volumes from the intended injection volumes increased at lower injection volumes, we compared the proportional injection volume error (loge [administered volume/intended volume]) for each of the 5 injection volumes using a linear regression model. Analysis of variance was used to determine whether the absolute log proportional error differed by the intended injection volume. Interindividual and intraindividual deviation from the intended injection volume was also characterized.
As the intended injection volumes decreased, the absolute log proportional injection volume error increased (analysis of variance, P < .0018). The exploratory analysis revealed no significant difference in the standard deviations of the log proportional errors for injection volumes between physicians and pediatric PACU nurses; however, the difference in absolute bias was significantly higher for nurses with a 2-sided significance of P = .03.
Clinically significant dose variation occurs when injecting volumes ≤0.5 mL. Administering small volumes of medications may result in unintended medication administration errors.
在围手术期，麻醉师和麻醉后护理单元（PACU）护士通常会准备和给予小容量静脉注射，但在这种情况下，给药体积的准确性尚未描述。在这项离体研究中，我们试图描述一组儿科麻醉师和儿科 PACU 护士在小容量注射（≤0.5 毫升）时与预期注射量的偏差程度。我们假设，随着预期注射量的减少，与预期注射量的偏差会增加。
10 名主治儿科麻醉师和 10 名儿科 PACU 护士每人对模拟患者的静脉注射装置进行了 10 次注射。从业者使用单独的 1 毫升结核菌素注射器，带有可移动的 18 号针头（Becton-Dickinson & Company，富兰克林湖，NJ），从橡胶塞小瓶中抽取 5 种不同体积（0.025、0.05、0.1、0.25 和 0.5 毫升）的 0.25 毫摩尔 Lucifer Yellow（LY）荧光染料，构成生理盐水（Sigma Aldrich，圣路易斯，MO）。然后，每位参与者通过三通阀将指定体积的 LY 荧光染料注入带有自由流动的 0.9%氯化钠（10 毫升/分钟）的静脉管中。注入的 LY 荧光染料和 0.9%氯化钠然后排入收集瓶中进行实验室分析。使用 Infinite M1000 微量板荧光波长检测（Tecan，Mannedorf，瑞士）测量收集液体的荧光。根据收集液体的荧光，使用已知 LY 体积和相关荧光的校准曲线计算给药体积。为了确定在较低注射量时，给药量与预期注射量的偏差是否增加，我们使用线性回归模型比较了 5 种注射量中的每一种的比例注射量误差（loge[给药量/预期量]）。方差分析用于确定预期注射量的绝对对数比例误差是否不同。还描述了个体间和个体内与预期注射量的偏差。
随着预期注射量的减少，绝对对数比例注射量误差增加（方差分析，P <.0018）。探索性分析表明，医生和儿科 PACU 护士之间的对数比例误差的标准差没有显著差异；然而，护士的绝对偏差差异具有统计学意义，双侧 P =.03。
当注射量≤0.5 毫升时，会出现临床显著的剂量变化。给予小剂量药物可能会导致意外的药物给药错误。
