静脉注射阿片类药物输注和癌症疼痛管理的实践和看法。
Practices and perceptions regarding intravenous opioid infusion and cancer pain management.
机构信息
Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer, Houston, Texas.
Department of Nursing, The University of Texas MD Anderson Cancer, Houston, Texas.
出版信息
Cancer. 2019 Nov 1;125(21):3882-3889. doi: 10.1002/cncr.32380. Epub 2019 Jul 10.
BACKGROUND
In view of the recent opioid crisis, ways to promote safe and effective opioid-related practices are needed. Faster intravenous (iv) opioid infusion rates can result in increased adverse effects and risk for nonmedical opioid use. Data on best practices regarding safe iv opioid administration for cancer pain are limited. This study examined iv opioid bolus infusion practices and perceptions about opioids in cancer pain among 4 groups of inpatient oncology nurses.
METHODS
An anonymous cross-sectional survey was conducted among oncology nurses working in medical, surgical, intensive care unit (ICU), and emergency department (ED) settings. An iv opioid bolus infusion speed less than 120 seconds was considered too fast.
RESULTS
The participant response rate was 59% (731 of 1234). Approximately 58%, 54%, and 58% of all nurses administered morphine, hydromorphone, and fentanyl, respectively, in less than 120 seconds. The median morphine infusion speeds were 55, 60, 60, and 85 seconds for ICU, surgical, ED, and medical unit nurses, respectively (P = .0002). The odds ratios for infusing too fast were 2.04 and 2.52 for ED (P = .039) and ICU nurses (P = .003), respectively, in comparison with medical unit nurses, and they were 0.27 and 0.18 with frequent (P = .003) and very frequent use of a timing device (P = .0001), respectively, in comparison with no use.
CONCLUSIONS
More than half the nurses working in the inpatient setting reported administering iv opioids too fast. ICU nurses administered opioids the fastest. Nurses who frequently used a timing device were less likely to infuse too fast. Further research is needed to standardize and improve the safe intermittent administration of iv opioids to patients with cancer.
背景
鉴于最近的阿片类药物危机，需要寻找能够促进安全有效的阿片类药物相关实践的方法。更快的静脉（iv）阿片类药物输注速度可能会导致不良反应增加和非医疗用途阿片类药物使用的风险增加。关于癌症疼痛安全 iv 阿片类药物给药的最佳实践数据有限。本研究调查了 4 组住院肿瘤科护士中 iv 阿片类药物推注输注实践和对癌症疼痛中阿片类药物的看法。
方法
对在医疗、外科、重症监护病房（ICU）和急诊室（ED）工作的肿瘤科护士进行了一项匿名横断面调查。iv 阿片类药物推注输注速度小于 120 秒被认为太快。
结果
参与者的回复率为 59%（731/1234）。大约 58%、54%和 58%的护士分别在 120 秒内给予吗啡、氢吗啡酮和芬太尼。ICU、外科、ED 和内科护士的吗啡输注速度中位数分别为 55、60、60 和 85 秒（P=0.0002）。与内科护士相比，ED 和 ICU 护士输注过快的优势比分别为 2.04 和 2.52（P=0.039）和（P=0.003），而频繁（P=0.003）和非常频繁（P=0.0001）使用计时设备时，他们的优势比分别为 0.27 和 0.18。
结论
超过一半的住院护士报告过快地给予 iv 阿片类药物。ICU 护士输注阿片类药物最快。经常使用计时设备的护士不太可能输注过快。需要进一步研究，以标准化和改善癌症患者 iv 阿片类药物的安全间歇性给药。
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