Lichliter Royanne L, Tremewan Lynea E, Shonka Nicole M, Mehnert Jennifer E, Brennan Laney, Thrasher Jodi M, Hernandez Teri L
Texas Children's Hospital, Houston, TX, USA.
Children's Hospital Colorado, Aurora, CO, USA.
J Spec Pediatr Nurs. 2018 Apr;23(2):e12212. doi: 10.1111/jspn.12212. Epub 2018 Feb 20.
Repeated venipunctures and fingersticks to confirm serum drug concentrations cause pain and dissatisfaction for pediatric patients and their families. In many organizations, the standard of care to obtain therapeutic serum drug concentrations by peripheral venipuncture or capillary fingerstick, even when the patient has an existing peripheral intravenous catheter (PIV) or central venous catheter (CVC). The primary objective of this study was to assess agreement between serum tobramycin/vancomycin concentrations collected from a CVC or PIV, versus venipuncture or fingerstick. Among hospitalized pediatric patients (age 3 months to 22 years), 36 paired blood samples were collected. Serum trough vancomycin and random tobramycin concentrations were compared between peripheral intravenous or CVC samples, and venipuncture or fingerstick samples within the same patient. A strict sampling protocol for obtaining the samples was followed, that included collection of the CVC/PIV sample before the venipuncture or fingerstick, less than 2 min between collections of samples from the different sites, and a strict volume-based flush and waste protocol. Concordant correlation coefficients demonstrated substantial agreement between CVC/PIV and venipuncture/fingerstick concentrations for vancomycin (n = 17) and tobramycin (n = 19) (Rc = 0.982 for both). Bland-Altman analyses demonstrated good overall between-method agreement within subjects and minimal bias. Consequently, using a lumen volume-based flush and waste protocol, children with indwelling catheters may not require additional venipunctures and/or fingersticks for confirmation of drug concentrations while hospitalized, improving the quality of care and patient satisfaction.
反复进行静脉穿刺和指尖采血以确认血清药物浓度会给儿科患者及其家属带来痛苦和不满。在许多机构中，即使患者已有外周静脉导管（PIV）或中心静脉导管（CVC），通过外周静脉穿刺或毛细血管指尖采血来获取治疗性血清药物浓度仍是护理标准。本研究的主要目的是评估从CVC或PIV采集的血清妥布霉素/万古霉素浓度与静脉穿刺或指尖采血之间的一致性。在住院儿科患者（年龄3个月至22岁）中，采集了36对血样。比较同一患者外周静脉或CVC样本与静脉穿刺或指尖采血样本之间的血清万古霉素谷浓度和随机妥布霉素浓度。遵循严格的样本采集方案，包括在静脉穿刺或指尖采血之前采集CVC/PIV样本，不同部位样本采集间隔少于2分钟，以及严格的基于体积的冲洗和废弃方案。一致性相关系数表明，万古霉素（n = 17）和妥布霉素（n = 19）的CVC/PIV与静脉穿刺/指尖采血浓度之间具有高度一致性（两者的Rc均为0.982）。Bland-Altman分析表明，受试者内部总体方法间一致性良好且偏差极小。因此，采用基于管腔容积的冲洗和废弃方案，留置导管的儿童在住院期间可能无需额外的静脉穿刺和/或指尖采血来确认药物浓度，从而提高护理质量和患者满意度。
