25 research outputs found
Optimisation des montages de perfusion en anesthésie-réanimation : au travers d'expériences cliniques
For the simultaneous administration of injectable drugs, the infusion line includes a main line with one or several derivative lines. The main line, which is directly connected to the catheter, is dedicated to hydration infusion or to maintain a permeable vein. Other medications will be added on the derivative lines.Intensive care unit patients frequently require lots of medications in the same time. Most of emergency drugs are substances with narrow therapeutic range. When concentrated solutions are employed, tiny mass flow rate disturbances can provoke clinical damages, such as haemodynamic instability. So, several parameters have been studied on simultaneous infusions: mass flow rate and syringes changeovers.The purpose of this work was to develop and optimize complex infusion line systems. An innovative infusion medical device has been evaluated in clinical trials and in vitro studies. The final objective was to design an optimized infusion line, which could be applied to ICUs.The whole medical devices used in ICUs was first listed. Then, noradrenaline has been used as the reference drug to study central venous catheter proximal line. A 0.5 mg/mL noradrenaline solution Y-infused with a saline (5mL/h) has been shown by clinical and in vitro data to be the best solution. Nevertheless, this conclusion was valid only with the use of a very low dead-space volume Y-extension set. Thanks to this device, syringe changeovers optimization is possible.The central venous catheter distal line has been studied in a second time through an open randomized controlled prospective clinical trial. Primary endpoint of the study was the impact of two different insulin infusion lines (Edelvaiss-Multiline 8, Doran International versus standard line) on glycaemic variability. Doranâs innovative device consists of an extenÂŹsion set with eight accesses connected to nine separated lumens in a single tube. This allows to dedicate an isolated way for insulin. With its use, a significant decrease of hypoglycaemia occurring in 1000h of infusion period was clinically demonstrated. Finally, all the data were synthetized to optimize an ICU multi-infusion line. The one, which has been designed for surgery and intensive care units, was tested on patients.To conclude, items responsible for mass flow rate disturbances have been identified: medical devices material, addition of appropriated valves, internal volume line minimization and use of automated infusion systems (as pumps). The ideal infusion line has to take into account all these parameters.Au cours de lâadministration simultanĂ©e de plusieurs mĂ©dicaments injectables, sont utilisĂ©es une ligne principale de perfusion et une ou plusieurs ligne(s) en dĂ©rivation. La ligne principale est directement reliĂ©e au cathĂ©ter et permet lâadministration des solutions utilisĂ©es pour lâapport hydro-Ă©lectrolytique ou de maintenir une voie dâabord veineuse permĂ©able. Les autres thĂ©rapeutiques vont ĂȘtre perfusĂ©es en dĂ©rivation de cette ligne principale. La prise en charge des patients relevant de soins intensifs et de rĂ©animation nĂ©cessite une polymĂ©dication. Les traitements dâurgence impliquent majoritairement des mĂ©dicaments Ă marge thĂ©rapeutique Ă©troite. Lors de lâadministration de mĂ©dicaments en solutions concentrĂ©es, de faibles perturbations du dĂ©bit dâadministration peuvent engendrer de fortes perturbations cliniques et notamment, pour les mĂ©dicaments vasoactifs, crĂ©er une instabilitĂ© hĂ©modynamique. Câest pourquoi il est important dâĂ©tudier la problĂ©matique de la perfusion simultanĂ©e, de dĂ©terminer lâimpact sur le dĂ©bit massique des lignes de perfusion et la technique optimale des changements de seringues pour prĂ©venir les variations intempestives du dĂ©bit de perfusion. Ce mĂ©moire prĂ©sente un travail de dĂ©veloppement et dâĂ©valuation dâune dĂ©marche dâoptimisation dâun systĂšme de perfusion complexe. Il consiste Ă Ă©tudier au travers dâĂ©valuations in vitro et dâĂ©tudes cliniques la conception dâune ligne de perfusion en Ă©valuant notamment un dispositif mĂ©dical innovant afin de proposer, in fine, une solution applicable dans un service de soins intensifs. La premiĂšre partie consiste Ă prĂ©senter lâensemble des dispositifs mĂ©dicaux de perfusion utilisĂ©s dans un dĂ©partement dâanesthĂ©sie-rĂ©animation. La seconde partie sâintĂ©resse Ă lâadministration dâun mĂ©dicament couramment perfusĂ© sur la voie proximale: la noradrĂ©naline. Les Ă©tudes in vitro, corroborĂ©es par des donnĂ©es cliniques, ont permis de montrer la supĂ©rioritĂ© de lâadministration de noradrĂ©naline Ă 0,5 mg/mL perfusĂ©e en Y avec une solution saline isotonique Ă dĂ©bit fixe de 5 mL/h. Cette multiperfusion fait intervenir lâutilisation dâun prolongateur trois voies Ă faible volume rĂ©siduel, permettant dâoptimiser les conditions de relais de seringues, connues comme Ă©tant Ă lâorigine dâinstabilitĂ©s hĂ©modynamiques chez les patients traitĂ©s par catĂ©cholamines. Un programme hospitalier de recherche clinique interrĂ©gional est dĂ©posĂ© dans le but dâĂ©tablir des recommandations de perfusion des catĂ©cholamines.La troisiĂšme partie aborde lâadministration des mĂ©dicaments sur voie distale en sĂ©lectionnant lâinsuline comme marqueur-mĂ©dicament. Les rĂ©sultats de cette Ă©tude clinique prospective randomisĂ©e contrĂŽlĂ©e ont montrĂ© que lâutilisation dâun dispositif mĂ©dical innovant, le dispositif Edelvaiss-Multiline 8 (Doran International) caractĂ©risĂ© par un tube multilumiĂšres Ă faible volume rĂ©siduel qui permet de dĂ©dier une voie Ă une seule thĂ©rapeutique, permettait de rĂ©duire significativement le temps passĂ© en hypoglycĂ©mie pour 1000 heures de perfusion dâinsuline au cours de perfusion continue dâinsuline en soins intensifs pĂ©riopĂ©ratoires.Enfin, dans une derniĂšre partie, les critĂšres clĂ©s dâun montage optimisĂ© de multiperfusion sont Ă©laborĂ©s et sont mis en application dans un dĂ©partement dâanesthĂ©sie-rĂ©animation dans le but dâoptimiser et uniformiser la ligne de perfusion des patients. Ce travail a permis de valider les caractĂ©ristiques clĂ©s de la ligne de perfusion dĂ©finis dans de prĂ©cĂ©dentes Ă©tudes non cliniques : la nature du matĂ©riau des dispositifs mĂ©dicaux utilisĂ©s, lâutilisation de valves appropriĂ©es, la minimisation des volumes internes des tubulures de perfusion, lâutilisation de systĂšmes de perfusion automatisĂ©s permettant de contrĂŽler au mieux le dĂ©bit dâadministration des mĂ©dicaments
Optimization of infusion lines in intensive care units : through clinical experiences
Au cours de lâadministration simultanĂ©e de plusieurs mĂ©dicaments injectables, sont utilisĂ©es une ligne principale de perfusion et une ou plusieurs ligne(s) en dĂ©rivation. La ligne principale est directement reliĂ©e au cathĂ©ter et permet lâadministration des solutions utilisĂ©es pour lâapport hydro-Ă©lectrolytique ou de maintenir une voie dâabord veineuse permĂ©able. Les autres thĂ©rapeutiques vont ĂȘtre perfusĂ©es en dĂ©rivation de cette ligne principale. La prise en charge des patients relevant de soins intensifs et de rĂ©animation nĂ©cessite une polymĂ©dication. Les traitements dâurgence impliquent majoritairement des mĂ©dicaments Ă marge thĂ©rapeutique Ă©troite. Lors de lâadministration de mĂ©dicaments en solutions concentrĂ©es, de faibles perturbations du dĂ©bit dâadministration peuvent engendrer de fortes perturbations cliniques et notamment, pour les mĂ©dicaments vasoactifs, crĂ©er une instabilitĂ© hĂ©modynamique. Câest pourquoi il est important dâĂ©tudier la problĂ©matique de la perfusion simultanĂ©e, de dĂ©terminer lâimpact sur le dĂ©bit massique des lignes de perfusion et la technique optimale des changements de seringues pour prĂ©venir les variations intempestives du dĂ©bit de perfusion. Ce mĂ©moire prĂ©sente un travail de dĂ©veloppement et dâĂ©valuation dâune dĂ©marche dâoptimisation dâun systĂšme de perfusion complexe. Il consiste Ă Ă©tudier au travers dâĂ©valuations in vitro et dâĂ©tudes cliniques la conception dâune ligne de perfusion en Ă©valuant notamment un dispositif mĂ©dical innovant afin de proposer, in fine, une solution applicable dans un service de soins intensifs. La premiĂšre partie consiste Ă prĂ©senter lâensemble des dispositifs mĂ©dicaux de perfusion utilisĂ©s dans un dĂ©partement dâanesthĂ©sie-rĂ©animation. La seconde partie sâintĂ©resse Ă lâadministration dâun mĂ©dicament couramment perfusĂ© sur la voie proximale: la noradrĂ©naline. Les Ă©tudes in vitro, corroborĂ©es par des donnĂ©es cliniques, ont permis de montrer la supĂ©rioritĂ© de lâadministration de noradrĂ©naline Ă 0,5 mg/mL perfusĂ©e en Y avec une solution saline isotonique Ă dĂ©bit fixe de 5 mL/h. Cette multiperfusion fait intervenir lâutilisation dâun prolongateur trois voies Ă faible volume rĂ©siduel, permettant dâoptimiser les conditions de relais de seringues, connues comme Ă©tant Ă lâorigine dâinstabilitĂ©s hĂ©modynamiques chez les patients traitĂ©s par catĂ©cholamines. Un programme hospitalier de recherche clinique interrĂ©gional est dĂ©posĂ© dans le but dâĂ©tablir des recommandations de perfusion des catĂ©cholamines.La troisiĂšme partie aborde lâadministration des mĂ©dicaments sur voie distale en sĂ©lectionnant lâinsuline comme marqueur-mĂ©dicament. Les rĂ©sultats de cette Ă©tude clinique prospective randomisĂ©e contrĂŽlĂ©e ont montrĂ© que lâutilisation dâun dispositif mĂ©dical innovant, le dispositif Edelvaiss-Multiline 8 (Doran International) caractĂ©risĂ© par un tube multilumiĂšres Ă faible volume rĂ©siduel qui permet de dĂ©dier une voie Ă une seule thĂ©rapeutique, permettait de rĂ©duire significativement le temps passĂ© en hypoglycĂ©mie pour 1000 heures de perfusion dâinsuline au cours de perfusion continue dâinsuline en soins intensifs pĂ©riopĂ©ratoires.Enfin, dans une derniĂšre partie, les critĂšres clĂ©s dâun montage optimisĂ© de multiperfusion sont Ă©laborĂ©s et sont mis en application dans un dĂ©partement dâanesthĂ©sie-rĂ©animation dans le but dâoptimiser et uniformiser la ligne de perfusion des patients. Ce travail a permis de valider les caractĂ©ristiques clĂ©s de la ligne de perfusion dĂ©finis dans de prĂ©cĂ©dentes Ă©tudes non cliniques : la nature du matĂ©riau des dispositifs mĂ©dicaux utilisĂ©s, lâutilisation de valves appropriĂ©es, la minimisation des volumes internes des tubulures de perfusion, lâutilisation de systĂšmes de perfusion automatisĂ©s permettant de contrĂŽler au mieux le dĂ©bit dâadministration des mĂ©dicaments.For the simultaneous administration of injectable drugs, the infusion line includes a main line with one or several derivative lines. The main line, which is directly connected to the catheter, is dedicated to hydration infusion or to maintain a permeable vein. Other medications will be added on the derivative lines.Intensive care unit patients frequently require lots of medications in the same time. Most of emergency drugs are substances with narrow therapeutic range. When concentrated solutions are employed, tiny mass flow rate disturbances can provoke clinical damages, such as haemodynamic instability. So, several parameters have been studied on simultaneous infusions: mass flow rate and syringes changeovers.The purpose of this work was to develop and optimize complex infusion line systems. An innovative infusion medical device has been evaluated in clinical trials and in vitro studies. The final objective was to design an optimized infusion line, which could be applied to ICUs.The whole medical devices used in ICUs was first listed. Then, noradrenaline has been used as the reference drug to study central venous catheter proximal line. A 0.5 mg/mL noradrenaline solution Y-infused with a saline (5mL/h) has been shown by clinical and in vitro data to be the best solution. Nevertheless, this conclusion was valid only with the use of a very low dead-space volume Y-extension set. Thanks to this device, syringe changeovers optimization is possible.The central venous catheter distal line has been studied in a second time through an open randomized controlled prospective clinical trial. Primary endpoint of the study was the impact of two different insulin infusion lines (Edelvaiss-Multiline 8, Doran International versus standard line) on glycaemic variability. Doranâs innovative device consists of an extenÂŹsion set with eight accesses connected to nine separated lumens in a single tube. This allows to dedicate an isolated way for insulin. With its use, a significant decrease of hypoglycaemia occurring in 1000h of infusion period was clinically demonstrated. Finally, all the data were synthetized to optimize an ICU multi-infusion line. The one, which has been designed for surgery and intensive care units, was tested on patients.To conclude, items responsible for mass flow rate disturbances have been identified: medical devices material, addition of appropriated valves, internal volume line minimization and use of automated infusion systems (as pumps). The ideal infusion line has to take into account all these parameters
Les apprenants du Valentin implantent un verger "zéro phyto"
En avril 2018, Ă la suite dâune dĂ©marche collaborative entre les Ă©quipes de lâĂ©tablissement agricole du Valentin, les apprenants et les chercheurs de lâINRA, nous avons plantĂ© un verger de 1000 mÂČ, en plaqueminiers et figuiers, qui sera conduit en « ZĂ©ro phyto ». Ce projet repose sur un modĂšle de verger multistrates qui permet de supprimer les produits phytopharmaceutiques du systĂšme de culture. Lâambition est de mettre en place un systĂšme Ă©conomiquement viable et adaptĂ© Ă son contexte gĂ©ographique
Disturbance of Vancomycin Infusion Flow during Multidrug Infusion: Influence on Endothelial Cell Toxicity
Background: Phlebitis is a common side effect of vancomycin peripheral intravenous (PIV) infusion. As only one PIV catheter is frequently used to deliver several drugs to hospitalized patients through the same Y-site, perturbation of the infusion flow by hydration or other IV medication may influence vancomycin exposure to endothelial cells and modulate toxicity. Methods: We assessed the toxicity of variations in vancomycin concentration induced by drug mass flow variations in human umbilical vein endothelial cells (HUVECs), simulating a 24 h multi-infusion therapy on the same line. Results were expressed as the percentage of viable cells compared with a 100% control, and the Kruskal–Wallis test was used to assess the toxicity of vancomycin. Results: Our results showed that variations in vancomycin concentration did not significantly influence local toxicity compared to a fixed concentration of vancomycin. Nevertheless, the loss of cell viability induced by mechanical trauma mimicking multidrug infusion could increase the risk of phlebitis. Conclusion: To ensure that vancomycin-induced phlebitis must have other causes than variation in drug mass flow, further in vitro experiments should be performed to limit mechanical stress to frequent culture medium change
To what extent do the storage conditions of polyetherâbased polyurethane have an impact on diazepam delivery?
Interactions between medical device material and the drug itself have been evoked for polyurethane and may lead to underdosing. Polyurethane, sterilization mode, and the crosslinking level of the polymer have an influence on sorption. The aim here is to evaluate the impact of polyurethane conservation time and conditions as well as sterilization mode. Two polyurethane extension tubes were tested, one sterilized by ethylene oxide and the second by gamma radiation. Forced degradation experiments were performed. After 3 and 6 months of incubation, thermal properties, diazepam delivery and cytotoxicity of leachates were assessed. Diazepam delivery differs significantly according to the version of polyurethane. Sterilization however has no impact on diazepam delivery. No cytotoxicity was observed whatever the infusion tube and the aging conditions. In conclusion, sterilization procedures do not induce polyurethane degradation, but high temperature/relative humidity/time storage conditions lead to a slight degradation in polyurethane
In vitro assessment of the influence of intravenous extension set materials on insulin aspart drug delivery.
Insulin is a frequently prescribed drug in hospitals and is usually administered by syringe pumps with an extension line which can be made of various materials. Two insulin solutions were studied: an insulin analogue, NovorapidŸ which contains insulin aspart and two phenolic preservatives (e.g. phenol and metacresol) and Umuline rapideŸ with human insulin and metacresol as preservative. Some studies have indicated interactions between insulin, polyvinyl chloride (PVC) and polyethylene (PE). The aim of this work was to study such interactions between NovorapidŸ or Umuline rapideŸ and infusion extension line materials (PVC, PE and coextruded (PE/PVC)). Insulin solution at 1 IU/mL was infused at 2 mL/h over 24 hours with 16 different extension lines (8 in PVC, 3 in PE and 5 in PE/PVC). Ultra-Fast Liquid Chromatography with diode array detection (UFLC-DAD) was performed to quantify insulin (human and aspart) and preservatives (metacresol and phenol). Limited human insulin sorption was observed thirty minutes after the onset of infusion: 24.3 ± 12.9%, 3.1 ± 1.6% and 18.6 ± 10.0% for PVC, PE and PE/PVC respectively. With insulin aspart, sorption of about 5% was observed at the onset of infusion for all materials. However, there were interactions between phenol and especially metacresol with PVC, but no interactions with PE and PE/PVC. This study shows that insulin interacts with PVC, PE and PE/PVC at the onset of infusion. It also demonstrates that insulin preservatives interact with PVC, which may result in problems of insulin conservation and conformation. Some more studies are required to understand the clinical impact of the latter during infusion
Administration sous-cutanĂ©e du lacosamide : protocolisation de lâusage et retour dâexpĂ©rience
Criteria for choosing an intravenous infusion line intended for multidrug infusion in anaesthesia and intensive care units
International audienc
Analysis of particulate exposure during continuous drug infusion in critically ill adult patients: a preliminary proof-of-concept in vitro study.
In critically ill patients, drug incompatibilities frequently occur because of the number of drugs to be administered through a limited number of infusion lines. These are among the main causes of particulate contamination. However, little data is available to quantify particle exposure during simultaneous IV-drug infusion. The objective of this study was to evaluate the particulate matter potentially administered to critically ill patients. The particulate matter (between 1Â ÎŒm and 30Â mm) of infused therapies used in ICUs for patients suffering from either septic shock or acute respiratory distress syndrome was measured in vitro over 6Â h using a dynamic image analysis device, so that both overall particulate contamination and particle sizes could be determined. Data is presented according to the recommendations of the European Pharmacopoeia (â„â10 and 25Â ÎŒm). For the six experimental procedures (continuous infusion of norepinephrine, midazolam, sufentanil, heparin, 5% glucose, binary parenteral nutrition and discontinuous administrations of omeprazole, piperacillin/tazobactam and fluconazole), the overall number of particles over the 6-h infusion period was 8256 [5013; 15,044]. The collected values for the number of particles â„â10 and 25Â ÎŒm were 281 [118; 526] and 19 [7; 96] respectively. Our results showed that discontinuous administrations of drugs led to disturbances in particulate contamination. This work indicates the amount of particulate matter potentially administered to critically ill adult patients. Particulate contamination appears lower than previous measurements performed during multidrug IV therapies in children
Does DDI-Predictor Help Pharmacists to Detect Drug-Drug Interactions and Resolve Medication Issues More Effectively?
International audienceThe characterization of drug-drug interactions (DDIs) may require the use of several different tools, such as the thesaurus issued by our national health agency (i.e., ANSM), the metabolic pathways table from the Geneva University Hospital (GUH), and DDI-Predictor (DDI-P). We sought to (i) compare the three toolsâ respective abilities to detect DDIs in routine clinical practice and (ii) measure the pharmacist intervention rate (PIR) and physician acceptance rate (PAR) associated with the use of DDI-P. The three toolsâ respective DDI detection rates (in %) were measured. The PIRs and PARs were compared by using the area under the curve ratio given by DDI-P (RAUC) and applying a chi-squared test. The DDI detection rates differed significantly: 40.0%, 76.5%, and 85.2% for ANSM (The National Agency for the Safety of Medicines and Health Products), GUH and DDI-P, respectively (p 2, respectively (p < 0.001). The overall PAR was 85.1% and did not appear to depend on the RAUC category (p = 0.729). Our results showed that more pharmacist interventions were issued when details of the strength of the DDI were available. The three tools can be used in a complementary manner, with a view to refining medication adjustments