Department of Medical Technology and Clinical Physics, University Medical Centre Utrecht, GA Utrecht, The Netherlands.
Department of Neonatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands.
J Vasc Access. 2024 Jul;25(4):1121-1128. doi: 10.1177/11297298221146327. Epub 2023 Jan 27.
In multi-infusion therapy, multiple infusion pumps are connected to one single vascular access point. Interaction between pressure changes from different pumps may result in temporary dosing errors, which can be very harmful to the patient. It is known that these dosing errors occur. However, clinicians tend to find it hard to estimate the order of magnitude of these errors.
This research uses an existing mathematical model to create a bedside prediction tool that is able to provide clinicians with the dosing errors that will occur after flow rate changes in multi-infusion therapy. A panel of clinicians, consisting of both nurses and doctors, was formed, and, in order to assess the level of knowledge about dosing errors in multi-infusion, the panel was presented with four medication schedules in which a syringe exchange or change in flow rate took place. The panel was asked to predict the resulting dosing errors.
A prediction tool was developed that describes a two pump multi-infusion system and predicts dosing errors resulting from changing the flow rate at one pump. 44% of the panel members wrongly predicted the impact of changing the set flow of liquid A on the flow of liquid B that reaches the patient. Nobody was able to correctly predict the dosing deviation if a very small catheter was used. After the prediction tool was shown, the clinicians indicated they had a improved understanding of what deviations to expect and that the tool would be useful in understanding multi-infusion dosing errors.
Using the predictive tool to visualise the deviations from the set flow rate is an effective method to allow clinicians to gain insight in dosing errors in multi-infusion therapy. This knowledge can be used to better anticipate future dosing errors in clinical situations.
在多输液治疗中，多个输液泵连接到一个单一的血管通路点。来自不同泵的压力变化之间的相互作用可能导致暂时的给药错误，这对患者可能非常有害。已知这些给药错误会发生。然而，临床医生往往发现很难估计这些错误的数量级。
本研究使用现有的数学模型创建了一个床边预测工具，该工具能够为临床医生提供多输液治疗中流速变化后将发生的给药错误。组成了一个由护士和医生组成的临床医生小组，为了评估多输液中给药错误的知识水平，小组被提供了四个药物方案，其中发生了注射器更换或流速变化。小组被要求预测由此产生的给药错误。
开发了一种预测工具，描述了一个双泵多输液系统，并预测了改变一个泵的流速时产生的给药错误。44%的小组成员错误地预测了改变液体 A 的设定流速对到达患者的液体 B 流量的影响。如果使用非常小的导管，没有人能够正确预测给药偏差。在展示了预测工具后，临床医生表示他们对预期的偏差有了更好的理解，并且该工具将有助于理解多输液给药错误。
使用预测工具可视化设定流速的偏差是一种有效的方法，可以使临床医生深入了解多输液治疗中的给药错误。这种知识可用于更好地预测临床情况下未来的给药错误。
