Nkhani

Funso: Norepinephrine ndi mankhwala opezeka kwambiri omwe amaperekedwa kudzera m`nsinga (IV) ngati kulowetsedwa kosalekeza. Ndi Volopessor yomwe imatha kukakamizidwa kuti magazi azitha kuthamanga kwambiri ndi ana odwala akulu ndi ana omwe ali ndi hypotension kapena kugwedezeka komwe kumapitilira ngakhale madzi okwanira. Ngakhale zolakwitsa zazing'ono zomwe zimayamwa kapena mlingo, komanso kuchedwa kwa chithandizo, zimatha kuyambitsa mavuto. Ntchito yachipatala yapamtundu wambiri yaposachedwa zotsatira za kusanthula kofala (CCA) kwa zolakwika zomwe zidachitika mu 2020 ndi 2021. Kuyang'ana zochitika zingapo ndi CCA zomwe zimapangitsa kuti zikhale zoyambitsa ndi chiwopsezo cha dongosolo. Zambiri kuchokera ku pulogalamu ya bungwe la bungweli komanso mapampu kulowetsedwa mwanzeru adagwiritsidwa ntchito pozindikira zolakwika zomwe zingachitike.
ISMP idalandira malipoti 16 a Noradreline mu 2020 ndi 2021 kudzera munthawi ya ism National Versing Progration pulogalamu (ISP Merp). Pafupifupi gawo limodzi mwa magawo atatu a malipoti awa achita zoopsa zomwe zimakhudzana ndi mayina, zilembo, kapena kunyamula, koma palibe zolakwa zomwe zidanenedwa. Tasindikiza malipoti a zolakwa zisanu ndi ziwiri zakuthupi: zolakwika zinayi za dosing (Epulo 16, 2020; Ogasiti 26, 2021; 2022); cholakwika chimodzi cholakwika; cholakwika chimodzi cha kubatizika kolakwika kwa mankhwalawa; Kusokoneza mwangozi kwa kulowetsedwa kwa norepinephrone. Malipoti onse a 16 a ism adawonjezeredwa ku CCA multicnunter dongosolo laumoyo (n = 106) ndi zotsatira zopumira (n = 122) pazakudya zilizonse zomwe zimagwiritsidwa ntchito pansipa. Vuto la malipoti limaphatikizidwanso kupereka zitsanzo za zomwe zimayambitsa.
Mendulo. Tazindikira zinthu zingapo zokhudzana ndi zolakwa, kuphatikizapo kugwiritsa ntchito malamulo osafunikira popanda kugwiritsa ntchito malamulo, komanso zigawo zosatsimikizika kapena zigawo zamitengo sizigwiritsidwa ntchito). Nthawi zina magawo otchulidwa a titimited ndi okhwima kwambiri kapena osasinthika (mwachitsanzo, zowonjezerazo ndizovuta kwambiri), zomwe zimapangitsa kuti zikhale zovuta kwa anamwino kwambiri), kupangitsa kukhala kovuta kwa anamwino kuti atsatire magazi a wodwala. Nthawi zina, madokotala amatha kulembera Mlingo wolemera kapena wosakhazikika, koma nthawi zina amasokonezeka. Izi ndi bokosi la-Box Kuphatikiza apo, kuchedwa kudanenedwa kuti kufotokozedwa kuti kufotokozeredwa polamula popereka malangizo omwe adawalamulira kunaphatikizapo malangizo olemera komanso osapanga.
Dokotala amafunsa namwino kuti alembe mankhwala a Norepinephrine kwa wodwala yemwe alibe magazi. Namwino adalemba ndendende momwe dokotala amapangidwira pakamwa: 0.05 mcg / kg / min iv iv yandamale kutanthauza kuti chandamale (Map) Pamwamba pa 65 mmhg. Koma malangizo a dokotala amasakaniza kuchuluka kwa kuchuluka kwa kuchuluka kwa mlingo wopangidwa ndi kulemera: Pulogalamu ya bungwe lokhala ndi bungweli silinathe kutchera ma MCG / min / Mlingo wambiri pamlingo wolemera, mcg / kg / min. Mankhwalawa amayenera kuyang'ana malangizo ndi madotolo, omwe adawapangitsa kuti athetse kuwasamalira.
Konzekerani ndi kugawa. Kukonzekera kwakukulu ndi zolakwika zomwe zimachitika chifukwa cha ntchito yogwira ntchito mankhwala osokoneza bongo a mankhwala ogwiritsa ntchito mankhwala ogwirira ntchito. khalani kutopa. Zifukwa zina zofananira zopereka zolakwika zimaphatikizapo zilembo za Noradrenaline zobisika m'matumba olimba komanso osamvetsetsa ndi ogwira ntchito mankhwala achangu.
Kulowetsedwa kwa corepinephrine ndi nicardipine mu thumba lakuda lamdima lidalakwika. Kuti musungunuke wakuda, dongosolo la donsing limasindikiziritsa zilembo ziwiri, imodzi pa madzi kulowetsedwa panja ndi wina kunja kwa thumba la amber. Kuthana kwa norepinephrines kunayikidwa mosazindikira mapaketi a Amber adalemba "Nicardipine" asanagawire malonda kuti agwiritse ntchito ndi odwala osiyanasiyana komanso mosemphanitsa. Zolakwika sizinazindikiritse asanapereke kapena kugwedezeka. Wodwalayo yemwe adachitidwa ndi Nicardipine adapatsidwa norepinephrine koma sanayambitse kuvulaza kwa nthawi yayitali.
oyang'anira. Zolakwika zodziwika bwino zimaphatikizapo mlingo wolakwika kapena cholakwika chachikulu, cholakwika cholondola, komanso cholakwika cholondola cha mankhwala. Zambiri mwa zolakwitsa izi zimachitika chifukwa cha njira zolakwika za pampu ya kulowetsedwa, gawo chifukwa cha kupezeka kwa kusankha kwa mankhwalawa, onse ndi popanda iwo; Zolakwika; kulumikizana ndi kuyanjana kwa infaption kapena infusions kwa wodwalayo adayambitsa kulowetsedwa kolakwika kapena sikunayike mizereyi ndipo sinawatsatire poyambira kapena kuyambiranso kulowetsedwa. China chake chasokonekera zipinda zadzidzidzi ndi zipinda zogwirira ntchito, komanso kulumikizana pampu ndi zamagetsi zaumoyo zamagetsi (ehr) sizinapezeke. Zowonjezera zomwe zimatsogolera kuwonongeka kwa minofu yanenedwanso.
Namwino adapereka chidziwitso cha norepinephone monga momwe adawongolerire pamlingo wa 0.1 μg / kg / min. M'malo mopanga pampu kuti ipereke 0,1 mcg / kg / mphindi, namwino adapanga pampo kuti apereke 0,1 mcg / min. Zotsatira zake, wodwalayo adalandira nthawi 80 kawiri kuposa kutchulidwa kuposa zomwe zimatchulidwa. Pamene kulowetsedwa idanenedwa pang'onopang'ono ndikufikiridwa ndi 1.5 μg / min, namwino adaweruza kuti adafika pamalire a 1.5 μg / kg / min. Chifukwa chakuti wodwalayo akutanthauza kukakamizidwa kudakalipo, Volopessor yachiwiri idawonjezedwa.
Kufufuza ndi kusungidwa. Zolakwika zambiri zimachitika mukadzaza makabati opanga okha (madc) kapena kusintha miphika ya norepinephrine mu ngolo zokhotakhota. Chifukwa chachikulu cholakwira awa ndi cholembera chomwecho komanso kunyamula. Komabe, zifukwa zina zofala zimadziwikanso, monga kuchuluka kochepa kwambiri kwa infusions infinions ku ADC yomwe siyinali yokwanira kukwaniritsa zosowa za wodwala, zomwe zimapangitsa kuti muchepetse matenda am'masitolo akamapeza. Kulephera kusanthula barcode iliyonse ya mankhwalawa pomwe amasunga ADC ndi gwero lina lodziwika bwino lolakwitsa.
Wofatsa molakwika adasintha Adc ndi okonzeka 32 mg / 250 ml norepinephrine njira yopanga 4 mg / 250 premica. Namwino adakumana ndi vuto poyesa kulandira 4 mg / 250 ml norepinephrine kulowetsedwa kuchokera ku ADC. Barcode pa kulowetsedwa kulikonse sikunasungidwe musanayikidwe mu ADC. Namwino atazindikira kuti panali chikwama cha 32 ml mu ADC (chikuyenera kukhala mu gawo la ADC), adapempha kuti awone zowona. Norepinephrinephrane 4mg / 250ml Mayankho sapezeka m'mafakitale chifukwa chopanga opanga 4mg / 250ml, zomwe zimapangitsa kuchepetsedwa kusakanikirana.
Woyang'anira. Kuwunika kolakwika kwa odwala, kupatulidwa kwa infusiney infusions kunja kwa magawo, osayembekezera kuti chikwama chotsatira chotsatira chofunikira ndi chovuta kwambiri chowunikira.
Wodwala wakufa ndi malamulo oti "musazengereze" amalowetsedwa ndi norepinephone kuti banja lake lizinena zabwino. The norepinephrine kulowetsedwa adatha, ndipo kunalibe thumba lopumira mu ADC. Nthawi yomweyo namwino adatchulapo pharmacy ndipo amafuna chikwama chatsopano. Mankhwalawa analibe nthawi yokonzekera mankhwalawo asanachoke wodwalayo ndikumuuza banja labwino.
Ngozi. Zowopsa zonse zomwe sizinayambitse vuto lanu likuti lizomera ndikuphatikizanso zilembo zofananira kapena zamankhwala. Malipoti ambiri akuwonetsa kuti phukusi ndi kulembera mitundu yosiyanasiyana ya infinephrine informasions yoperekedwa ndi ma extioucers 503b zikuwoneka ngati zofanana.
Malangizo azochita zotetezeka. Onani mfundo zotsatirazi popanga kapena kubwereza njira yanu kuti muchepetse zolakwika mu kugwiritsa ntchito mosamala kwa norepinephrines (ndi vasopinesr) infusions:
Chepetsa nkhawa. Okhazikika kwa ochepa ocheperako mankhwalawa mankhwala a ana ndi / kapena akulu akulu odwala. Fotokozerani kuchuluka kwa zolemera kwambiri kuti musungidwe kwa odwala omwe ali ndi choletsa madzi kapena chofunikira kwambiri kwa norepinephrine (kuti muchepetse kusintha kwa thumba).
Sankhani njira imodzi yokha. Sinthani kulowetsedwa kwa norepinephy kulowetsedwa kwa thupi monga mwa thupi (McG / KG / Min) kapena popanda iyo (McG / Min) Kuchepetsa chiopsezo cholakwitsa. A ku America a American Health Mankhwala Odwala Mankhwala (Ashp) omwe amayambitsa chitetezo4 amalimbikitsa kugwiritsa ntchito mayusajinephine dospinephs / kg / mphindi. Zipatala zina zimatha kukonza mlingo wa micrograms pamphindi motengera zomwe dokotala amakonda - onse awiri ndi ovomerezeka, koma njira ziwiri zopangira siziloledwa.
Kufuna kupatsidwa kutumiza malinga ndi template yoyenera. Pamafunika mankhwala osokoneza bongo a norepinephy pogwiritsa ntchito template yotsimikizika yokhala ndi gawo lofunikira kwambiri, gawo la magazi), mlingo wa systolic (motalika) sayenera kupitilizidwa komanso / kapena kuti kupezeka kwa omwe akupezekapo kuyenera kutchedwa. Nthawi yosinthika iyenera kukhala "yodziwika" kwa izi kuti zichitike patsogolo pamzere wa pharmacy.
Chepetsani madongosolo. Chepetsani mafotokozedwe adzidzidzi pamwala kapena pomwe dokotala amalephera kulowa kapena kulemba madongosolo pakompyuta. Madokotala ayenera kupanga okha pokhapokha ngati pali zovuta zina.
Gulani mayankho okonzedwa okonzeka akapezeka. Gwiritsani ntchito njira zosinthira za Expinephriney kuchokera kwa opanga ndi / kapena mayankho okonzedwa ndi ogulitsa achitatu (monga 503b) kuti muchepetse nthawi yokonza mankhwala, ndikupewa zolakwika zamankhwala.
kukhazikika kwamitundu. Kusiyanitsa mitundu yosiyanasiyana yosiyanasiyana kuwapangitsa kuti awoneke popanda dosing.
Perekani kuchuluka kokwanira kwa ADC. Sungani pa ADC ndikupereka infusiney infusions yokumana ndi zosowa za odwala. Polojekiti kugwiritsa ntchito ndi kusintha miyezo ya muyeso ngati pakufunika.
Pangani njira zamakampani ogwiritsira ntchito ndi / kapena kuphatikizira. Chifukwa itha kutenga nthawi kusakaniza ndende yayikulu, pharmacies imatha kugwiritsa ntchito njira zosiyanasiyana kuti mukonzekere kukonzekera ndi kukamba, zomwe zimapangidwa ndi zidziwitso kapena zidziwitso za imelo zimayenera kukonzedwa.
Phukusi lililonse / vial limasambitsidwa. Pofuna kupewa zolakwa mukamakonzekera, kugawa, kapena kusungirako, sinthani barcode pa batineph iliyonse kapena vial kuti mutsimikizire asanakonzekere, kugawa, kapena kusungira adc. Barcode imatha kugwiritsidwa ntchito pazolemba zomwe zimakhazikika mwachindunji pa phukusi.
Chongani zilembo pa thumba. Ngati chikwama chowala chimagwiritsidwa ntchito pa cheke cha driotine, kulowetsedwa kwa norepinephrone uyenera kuchotsedwa kwakanthawi kuchikwama poyesedwa. Kapenanso, ikani thumba loteteza ku kulowetsedwa musanayesere ndikuyika m'thumba itayikidwa.
Pangani malangizo. Khazikitsani malangizo (kapena protocol) kulowetsedwa kuchokera ku norepinephrine (kapena mankhwala ena a Cidaticle), kuphatikizapo kuchuluka kwa ma cell, muyeso, ndi kuwunikira, ndi kuwunikira zofunika. Ngati ndi kotheka, ulumikizane ndi dongosolo laubatizi mu mankhwala omwe amalandila ngongole (Mar).
Gwiritsani ntchito pampu yanzeru. Onse akhungu a norepinephy amadzazidwa ndikulowetsedwa pogwiritsa ntchito pampu yanzeru yotsika kwambiri kotero kuti ders amatha kudziwa akatswiri azaumoyo (kuwerengetsa, kapena zolakwika.
Yambitsani kulumikizana. Ngati kuli kotheka, yambitsani mapampu a BI-BE-Servicence omwe akugwirizana ndi azachipatala amagetsi. Kuchitapo kanthu kumapangitsa mapampu kuti apangidwe ndi kulowetsedwa kotsimikizika kofotokozedwa ndi dokotala (osachepera nthawi yoyambira) komanso kumawonjezera mafinya am'mimba.
Ikani mizere ndikuyang'ana mapaipi. Lembani chilichonse kulowetsedwa pamwamba pa pampu ndipo pafupi ndi malo opezeka wodwala. Kuphatikiza apo, asanayambe kapena kusintha thumba la norepinephrinephine kapena kulowetsedwa kwa tubung kuchokera pampu ndi wodwala kuti atsimikizire kuti makonzedwe ake ndi olondola.
Vomerezani Kuyendera. Ngati kulowetsedwa kwatsopano kumayimitsidwa, kuyang'ana mwaukadaulo (mwachitsanzo, barcode) imayenera kutsimikizira mankhwala / yankho, mankhwala osokoneza bongo komanso oleza mtima.
Imani kulowetsedwa. Ngati wodwalayo ali wokhazikika mkati mwa maola awiri omwe asiya kulowetsedwa kwa norepinephrineque, lingalirani kupeza dongosolo lofufuzira kuchokera ku dokotala. Mukayamba kulowetsedwa, ndikupukutira kulowetsedwa kwa wodwalayo, kuchotsa kuchokera pampu, ndikutaya kuti apewe kuwongolera mwangozi. Kulowetsedwa amayeneranso kusinthidwanso kuchokera kwa wodwalayo ngati kulowetsedwa kumasokonekera kwa maola opitilira 2.
Khazikitsani Protocol Protocol. Khazikitsani protocol yowonjezera yopyapsing norepinephrine. Anamwino akuyenera kudziwitsidwa za mtundu uwu, kuphatikizapo kulandira machendomine mesylate ndi kupewa kuzizira kudera lomwe lakhudzidwalo, lomwe lingakulitse kuwonongeka kwa minofu.
Dziwitsani za ntchito. Moni oyang'anira kutsatira malangizo a malingaliro a kulowetsedwa kwa norepineph, protocols ndi malangizo enieni a dokotala, komanso zotsatira zake. Zitsanzo za ziyeso zimaphatikizapo kutsatira magawo a chotchedwa; kuchedwa kulandira chithandizo; Kugwiritsa ntchito mapampu anzeru okhala ndi derrs kumathandizidwa (komanso kugonana); Yambani kulowetsedwa kwa kuchuluka kokonzedweratu; kutumizira malingana pafupipafupi ndi magawo a chidole; Mpvammmmmpi yanzeru imakudziwitsani pafupipafupi komanso mtundu wa mlingo, zolembedwa za magawo a miyala (ziyenera kufanana ndi kusintha kwa mlingo) komanso kuvulaza wodwala.