Evaluation of an intravenous preparation information system for improving the reconstitution and dilution process

Jo, Yun Hee; Shin, Wonjae; Lee, Ju‐Yeun; Yang, Bo; Yu, Yun Mi; Kim, Hyang Sook

doi:10.1016/j.ijmedinf.2016.07.005

Cited by 6 publications

(8 citation statements)

References 54 publications

(71 reference statements)

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“…This could lead to a reduction in the lysis capacity of the drug through decreased concentration or deactivation of the effective constituent, or could result in precipitation of harmful chemical entities. 22 Because of the importance of ensuring no particulates are present in the reconstituted solution, it is suggested that, regardless of solution stability once fully reconstituted, prolonged exposure of lyophilized tenecteplase to high temperatures should be avoided.…”

Section: Discussionmentioning

confidence: 99%

The Effect of High Storage Temperature on the Stability and Efficacy of Lyophilized Tenecteplase

Henkel

Vella

Fenning

2020

Prehosp. Disaster med.

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Introduction: Tenecteplase is a thrombolytic protein drug used by paramedics, emergency responders, and critical care medical personnel for the prehospital treatment of blood clotting diseases. Minimizing the time between symptom onset and the initiation of thrombolytic treatment is important for reducing mortality and improving patient outcomes. However, the structure of protein drug molecules makes them susceptible to physical and chemical degradation that could potentially result in considerable adverse effects. In locations that experience extreme temperatures, lyophilized tenecteplase transported in emergency service vehicles (ESVs) may be subjected to conditions that exceed the manufacturer’s recommendations, particularly when access to the ambulance station is limited. Study Objective: This study evaluated the impact of heat exposure (based on temperatures experienced in an emergency vehicle during summer in a regional Australian city) on the stability and efficacy of lyophilized tenecteplase. Methods: Vials containing 50mg lyophilized tenecteplase were stored at 4.0°C (39.2°F), 35.5°C (95.9°F), or 44.9°C (112.8°F) for a continuous period of eight hours prior to reconstitution. Stability and efficacy were determined through assessment of: optical clarity and pH; analyte concentration using UV spectrometry; percent protein monomer and single chain protein using size-exclusion chromatography; and in vitro bioactivity using whole blood clot weight and fibrin degradation product (D-dimer) development. Results: Heat treatment, particularly at 44.9°C, was found to have the greatest impact on tenecteplase solubility; the amount of protein monomer and single chain protein lost (suggesting structural vulnerability); and the capacity for clot lysis in the form of decreased D-dimer production. Meanwhile, storage at 4.0°C preserved tenecteplase stability and in vitro bioactivity. Conclusion: The findings indicate that, in its lyophilized form, even relatively short exposure to high temperature can negatively affect tenecteplase stability and pharmacological efficacy. It is therefore important that measures are implemented to ensure the storage temperature is kept below 30.0°C (86.0°F), as recommended by manufacturers, and that repeated refrigeration-heat cycling is avoided. This will ensure drug administration provides more replicable thrombolysis upon reaching critical care facilities.

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Section: Discussionmentioning

confidence: 99%

The Effect of High Storage Temperature on the Stability and Efficacy of Lyophilized Tenecteplase

Henkel

Vella

Fenning

2020

Prehosp. Disaster med.

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“…Here, students were encouraged to rationalize probable connections between serial dilution methods and medicine preparation in healthcare. Presently, YouTube has an available video resource on both the dilution and reconstitution of medication, 17 in which the nurse demonstrates the dilution of famotidine and drug reconstitution of a pantoprazole using a saline solution. 18 Example Lab B: Adapting an Online "Solubility Product (K sp )" Chemistry Lab Experience for Health Sciences and Nonmajors.…”

Section: Fall Semesters 2017−2021 Example "Bridging Chemistry Tomentioning

confidence: 99%

“…Intravenous (IV) push antibiotics may require both reconstitution (of a powdered medication) and dilution (of the resulting aqueous solution) by nursing professionals. 17 Reconstitution of powdered medications requires a series of steps in which the nurse will practice solubility and dilution techniques: 18 (i) 0.9% sodium chloride (NaCl) may often be used as the solvent (for reconstitution) or diluent (for dilution methods); (ii) a syringe (and syringe cap) is often used in the reconstitution process; and (iii) patient name labels, (iv) alcohol wipes, (v) a biohazard disposal bin for sharp materials (i.e., syringes and needles), and (vi) the powdered medical vial are needed. This process requires the nurse (or healthcare personnel) to draw a given volume (mL) of the solvent (the normal saline solution) and inject it into the powdered medication vial (following sterilization of vial top with the alcohol wipe).…”

Section: Fall Semesters 2017−2021 Example "Bridging Chemistry Tomentioning

confidence: 99%

“…may vary by patient. In medical pharmacies or clinics, skilled technicians or nurses may dilute a stock solution of medication according to the prescribed dosages. − On the topic of “Bridging Chemistry and Medicine (Part 1)”, following virtual experimentation (dilution and monitoring pH) and pH calculations, students were instructed to submit a lab report, which would include the following discussion topic: What are some possible advantages for utilizing “serial dilution” in healthcare? Are there any scenarios, in which using “serial dilution” in healthcare, would be a disadvantage?…”

Section: Changing Lanes From “In-person Wet Labs” To “In-person 2d La...mentioning

confidence: 99%

“…The reconstitution of solid (i.e., powdered) drug reagents in clinics and other healthcare facilities is often performed by health professionals such as pharmacy personnel, nurses, and medical assistants. Intravenous (IV) push antibiotics may require both reconstitution (of a powdered medication) and dilution (of the resulting aqueous solution) by nursing professionals . Reconstitution of powdered medications requires a series of steps in which the nurse will practice solubility and dilution techniques: (i) 0.9% sodium chloride (NaCl) may often be used as the solvent (for reconstitution) or diluent (for dilution methods); (ii) a syringe (and syringe cap) is often used in the reconstitution process; and (iii) patient name labels, (iv) alcohol wipes, (v) a biohazard disposal bin for sharp materials (i.e., syringes and needles), and (vi) the powdered medical vial are needed.…”

Section: Changing Lanes From “In-person Wet Labs” To “In-person 2d La...mentioning

confidence: 99%

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Moving Forward: Resilience of a Chemistry for Health Professions 2D Virtual Lab Program During COVID

Mahaffey

2022

J. Chem. Educ.

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Chemical education laboratory practices have not been exempted from the present healthcare crisis. Learning environments have shifted from face-to-face exercises to virtual and video conferencing platforms. Here, we discuss a chemistry for health sciences course which (i) adapted the previous face-to-face laboratory exercises to 100% online using online platforms two years preceding COVID only to shift to completely remote learning and back again and (ii) highlight correlations between chemistry concepts (e.g., pH, solubility, and serial dilutions) and medical practices. Additionally, course pass/fail trends pre-COVID and during COVID are identified and discussed by the author. Regarding example laboratory teaching and learning, this article further examines the responses for two groups of students and their perspectives on 2D virtual chemistry lab experiences and parallel discussions in healthcare: (1) For group 1, students (n = 135) completed an anonymous and voluntary Likert-type questionnaire for a pH and serial dilution online lab experience with over 92% recommending the lab experience for future enrollees, and (2) for group 2, student (n = 107) results indicated 93% of the survey participants were providing the same recommendation.

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Electronic medication administration records and nursing administration of medications: An integrative review

Stolic

Ng²,

Sheridan³

2023

Collegian

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Evaluation of an intravenous preparation information system for improving the reconstitution and dilution process

Cited by 6 publications

References 54 publications

The Effect of High Storage Temperature on the Stability and Efficacy of Lyophilized Tenecteplase

The Effect of High Storage Temperature on the Stability and Efficacy of Lyophilized Tenecteplase

Moving Forward: Resilience of a Chemistry for Health Professions 2D Virtual Lab Program During COVID

Electronic medication administration records and nursing administration of medications: An integrative review

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