Department of Anesthesiology, Jackson Memorial Hospital, University of Miami, 1611 NW 12th Ave, SW 303, Miami, FL, 33136, USA.
J Clin Monit Comput. 2019 Aug;33(4):549-556. doi: 10.1007/s10877-018-0179-3. Epub 2018 Jul 10.
Injection ports used to administer medications and draw blood samples have inherent dead-volume. This volume can potentially lead to inadvertent drug administration, contribute to erroneous laboratory values by dilution of blood samples, and increase the risk of vascular air embolism. We sought to characterize provider practice in management of intravenous (IV) and arterial lines and measure dead-volumes of various injection ports. A survey was circulated to anesthesiology physicians and nurses to determine practice habits when administering medications and drawing blood samples. Dead-volume of one and four-way injection ports was determined by injecting methylene blue to simulate medication administration or blood sample aspiration and using absorption spectroscopy to measure sample concentration. Among the 65 survey respondents, most (64.52%) increase mainstream flow rate to flush medication given by a 1-way injection port. When using 4-way stopcocks, 56.45% flush through the same injection site. To obtain a sample from an arterial line, 67.74% draw back blood and collect the sample from the same 4-way stopcock; 32.26% use a different stopcock. Mean (SD) dead-volume in microliters ranged from 0.1 (0.0) to 5.6 (1.0) in 1-way injection ports and from 54.1 (2.8) to 126.5 (8.3) in 4-way injection ports. The practices of our providers when giving medications and drawing blood samples are variable. The dead-volume associated with injection ports used at our institution may be clinically significant, increasing errors in medication delivery and laboratory analysis.
用于给予药物和抽取血样的注射端口具有固有死腔。该体积可能导致无意中给药，通过稀释血样导致错误的实验室值，并增加血管空气栓塞的风险。我们旨在描述静脉（IV）和动脉管路的提供者管理实践，并测量各种注射端口的死腔量。向麻醉医师和护士分发了一项调查，以确定给药和抽取血样时的实践习惯。通过注射亚甲蓝模拟药物给药或血样抽吸来确定单路和四路注射端口的死腔量，并使用吸收光谱法测量样品浓度。在 65 名调查受访者中，大多数（64.52％）增加主流流速以冲洗通过单路注射端口给予的药物。当使用四路旋塞时，56.45％通过相同的注射部位冲洗。要从动脉管路获取样本，67.74％从同一四路旋塞中回抽血液并收集样本；32.26％使用不同的旋塞。在单路注射端口中，微升的平均（SD）死腔体积范围为 0.1（0.0）至 5.6（1.0），在四路注射端口中为 54.1（2.8）至 126.5（8.3）。我们的提供者在给药和抽取血样时的做法是多种多样的。与我们机构使用的注射端口相关的死腔量可能具有临床意义，会增加药物输送和实验室分析中的错误。
