Background Intravenous drug administration is associated with potential complications, such as phlebitis. The physiochemical characteristics of the infusate play a very important role in some of these problems. Aim The aim of this study was to standardize the dilutions of intravenous drugs most commonly used in hospitalized adult patients and to characterize their pH, osmolarity and cytotoxic nature to better guide the selection of the most appropriate vascular access. Methods The project was conducted in three phases: (i) standardization of intravenous therapy, which was conducted using a modified double-round Delphi method; (ii) characterization of the dilutions agreed on in the previous phase by means of determining the osmolarity and pH of each of the agreed concentrations, and recording the vesicant nature based on the information in literature; and (iii) algorithm proposal for selecting the most appropriate vascular access, taking into account the information gathered in the previous phases. Results In total, 112 drugs were standardized and 307 different admixtures were assessed for pH, osmolarity and vesicant nature. Of these, 123 admixtures (40%), had osmolarity values >600 mOsm/L, pH < 4 or > 9, or were classified as vesicants. In these cases, selection of the most suitable route of infusion and vascular access device is crucial to minimize the risk of phlebitis-type complications. Conclusions Increasing safety of intravenous therapy should be a priority in the healthcare settings. Knowing the characteristics of drugs to assess the risk involved in their administration related to their physicochemical nature may be useful to guide decision making regarding the most appropriate vascular access and devices.

No abstract

Resumen La ventilación mec anica es capaz de producir y agravar el daño pulmonar y contribuir a la aparición de fracaso multiorg anico. Uno de los mecanismos descritos es la hiperoxia alveolar que, en modelos experimentales, conlleva una producción de radicales libres de oxígeno (O 2 ) que exceden las posibilidades de defensa celular, y dan lugar a inflamación, a sobreexpresión gen etica y a daño celular directo con fenómenos de necrosis y apoptosis. Los hallazgos en humanos no son tan concluyentes, sí est a claramente demostrada una alteración funcional debida a la exposición a la fracción inspiratoria de O 2 (FiO 2 ) elevada y a un mayor desreclutamiento pulmonar en los pacientes con lesión pulmonar, y que tanto la FiO 2 empleada como la presión arterial de oxígeno conseguida en las primeras 24 h de ingreso est an relacionadas con la mortalidad. Sería necesario realizar ensayos clínicos que evalúen cu al es el umbral de la FiO 2 y de la saturación de O 2 seguro. & 2009 Elsevier España, S.L. y SEMICYUC. Todos los derechos reservados. KEYWORDS Hyperoxia; Lung injury; Artificial respiration; Adverse effects; ComplicationsHyperoxia induced pulmonary toxicity Abstract Mechanical ventilation may cause and aggravate lung damage and contribute to the appearance of multiorgan failure. One of the mechanisms that has been described is alveolar hyperoxia. In experimental models, it has lead to the production of free oxygen radicals that exceed the cell defense capacity, giving rise to inflammation, cell damage and gene overexpression with necrosis and apoptosis phenomenon. However, these findings in humans are not as conclusive, although a functional alteration due to the exposure to high FiO 2 , and greater lung de-recruitment in patients with lung injury has been clearly demonstrated. Moreover, both the FiO 2 used as well as the PaO 2 achieved in the first 24 h of admission are associated with mortality. Clinical trials are needed that assess the threshold of the safe oxygen level for FiO 2 and oxygen saturation.

No abstract