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Epinephrine syringe exchange events in a paediatric cardiovascular ICU: analysing the storm

Published online by Cambridge University Press:  04 December 2017

Barbara-Jo Achuff Open the ORCID record for Barbara-Jo Achuff [Opens in a new window] ,
Jameson C. Achuff ,
Hwan H. Park ,
Brady Moffett ,
Sebastian Acosta ,
Craig G. Rusin  and
Paul A. Checchia
Barbara-Jo Achuff*
Affiliation:
Cardiac Critical Care, Texas Children’s Hospital, Houston, Texas, United States of America
Jameson C. Achuff
Affiliation:
Applied Mathematics, Carnegie Melon University, Pittsburgh, Pennsylvania, United States of America
Hwan H. Park
Affiliation:
Applied Mathematics, Rice University, Houston, TX, United States of America
Brady Moffett
Affiliation:
Clinical Pharmacy, Texas Children’s Hospital, Houston, TX, United States of America
Sebastian Acosta
Affiliation:
Section of Cardiology, Baylor College of Medicine, Houston, Texas, United States of America
Craig G. Rusin
Affiliation:
Section of Cardiology, Baylor College of Medicine, Houston, Texas, United States of America
Paul A. Checchia
Affiliation:
Cardiac Critical Care, Texas Children’s Hospital, Houston, Texas, United States of America
*
Correspondence to: B.-J. Achuff, MD, FAAP, Cardiac Critical Care, Texas Children’s Hospital, 6621 Fannin Street Suite 6006, Houston, TX 77030, United States of America. Tel: +832 826 0614; Fax: +832 825 7422; E-mail: bxachuff@texaschildrens.org
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Abstract

Introduction

Haemodynamically unstable patients can experience potentially hazardous changes in vital signs related to the exchange of depleted syringes of epinephrine to full syringes. The purpose was to determine the measured effects of epinephrine syringe exchanges on the magnitude, duration, and frequency of haemodynamic disturbances in the hour after an exchange event (study) relative to the hours before (control).

Materials and methods

Beat-to-beat vital signs recorded every 2 seconds from bedside monitors for patients admitted to the paediatric cardiovascular ICU of Texas Children’s Hospital were collected between 1 January, 2013 and 30 June, 2015. Epinephrine syringe exchanges without dose/flow change were obtained from electronic records. Time, magnitude, and duration of changes in systolic blood pressure and heart rate were characterised using Matlab. Significant haemodynamic events were identified and compared with control data.

Results

In all, 1042 syringe exchange events were found and 850 (81.6%) had uncorrupted data for analysis. A total of 744 (87.5%) exchanges had at least 1 associated haemodynamic perturbation including 2958 systolic blood pressure and 1747 heart-rate changes. Heart-rate perturbations occurred 37% before exchange and 63% after exchange, and 37% of systolic blood pressure perturbations happened before syringe exchange, whereas 63% occurred after syringe exchange with significant differences found in systolic blood pressure frequency (p<0.001), duration (p<0.001), and amplitude (p<0.001) compared with control data.

Conclusions

This novel data collection and signal processing analysis showed a significant increase in frequency, duration, and magnitude of systolic blood pressure perturbations surrounding epinephrine syringe exchange events.

Keywords

cardiac critical carevasoactive medicationsyringe pumpdrug deliveryquality
Type
Original Articles
Information
Cardiology in the Young , Volume 28 , Issue 3 , March 2018 , pp. 409 - 415
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Copyright
© Cambridge University Press 2017 

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References

1. Lonnqvist, PA, Lofqvist, B. Design flaws can convert commercially available continuous syringe pumps into intermittent bolus injectors. Intensive Care Med 1997; 23: 998–1001.Google ScholarPubMed
2. Igarashi, H, Obata, Y, Nakajima, Y, et al. Syringe pump displacement alters line internal pressure and flow. Can J Anaesth 2005; 527: 685–691.Google Scholar
3. Van Der Eijk, AC, Van Rens, RM, Dankelman, J, et al. A literature review on flow-rate variability in neonatal IV therapy. Paediatr Anaesth 2013; 23: 9–21.CrossRefGoogle ScholarPubMed
4. Lovich, MA, Wakim, MG, Wei, A, et al. Drug infusion system manifold dead-volume impacts the delivery response time to changes in infused medication doses in vitro and also in vivo in anesthetized swine. Anesth Analg 2013; 117: 1313–1318.Google Scholar
5. Argaud, L, Cour, M, Martin, O, et al. Changeovers of vasoactive drug infusion pumps: impact of a quality improvement program. Crit Care Med 2007; 11: R133.Google Scholar
6. Leff, RD, Roberts, R. Problems in drug therapy for pediatric patients. Am J Hosp Pharm 1987; 44: 865–870.Google Scholar
7. Arino, M, Barrington, JP, Morrison, AL, et al. Management of the changeover of inotrope infusions in children. Intensive Crit Care Nurs 2004; 20: 275–280.Google Scholar
8. Trim, JC, Roe, J. Practical considerations in the administration of intravenous vasoactive drugs in the critical care setting: the double pumping or piggyback technique – part one. Intensive Crit Care Nurs 2004; 20: 153–160.CrossRefGoogle ScholarPubMed
9. Klem, SA, Farrington, JM, Leff, RD. Influence of infusion pump operation and flow rate on hemodynamic stability during epinephrine infusion. Crit Care Med 1993; 21: 1213.Google Scholar
10. Rooke, GA, Bowdle, T. Syringe pumps for infusion of vasoactive drugs: mechanical idiosyncrasies and recommended operating procedures. Anesth Analg 1994; 78: 150–156.CrossRefGoogle ScholarPubMed
11. Dünser, MW, Hasibeder, WR. Sympathetic overstimulation during critical illness: adverse effects of adrenergic stress. J Intensive Care Med 2009; 24: 293–316.Google Scholar
12. Giraud, T, Dhainaut, JF, Vaxelaire, JF, et al. Iatrogenic complications in adult intensive care units: a prospective two-center study. Crit Care Med 1993; 21: 40–51.Google Scholar
13. Neff, T, Fischer, J, Fehr, S, et al. Start‐up delays of infusion syringe pumps. Pediatr Anesth 2001; 11: 561–565.Google Scholar
14. Larsen, GY, Parker, HB, Cash, J, et al. Standard drug concentrations and smart-pump technology reduce continuous-medication-infusion errors in pediatric patients. Pediatrics 2005; 116: 21–25.CrossRefGoogle ScholarPubMed
15. Vu, EL, Rusin, CG, Penny, DJ, et al. A novel electrocardiogram algorithm utilizing ST-segment instability for detection of cardiopulmonary arrest in single ventricle physiology: a retrospective study. Pediatr Crit Care Med 2017; 18: 44–53.Google Scholar