Analgesic effect and safety of using an epidural analgesia pump versus an intravenous analgesia pump for uterine artery embolization in the treatment of uterine fibroids / 中国基层医药

Objective:To investigate the analgesic effect and safety of using an epidural analgesia pump versus an intravenous analgesia pump for uterine artery embolization in the treatment of uterine fibroids. Methods:Fifty patients with uterine fibroids undergoing uterine artery embolization admitted to The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University from January 2019 to December 2021 were included in this study. They were divided into an observation group and a control group ( n = 25/group). Patients in the observation group used an epidural analgesia pump for pain relief, while patients in the control group used an intravenous analgesia pump for pain relief. At 1, 6, 12, and 24 hours after surgery, pain severity was compared between the two groups using the Visual Analogue Scale. Comfort level was compared between the two groups using the Bruggemann Comfort scale. Before and after surgery, respiratory rate, heart rate, blood pressure, and adverse reactions were compared between the two groups. Results:At 1 hour after surgery, the Visual Analogue Scale score in the observation group was significantly lower than that in the control group [3.00 (2.00, 5.50) vs. 7.00 (6.00, 8.00), Z = -3.84, P < 0.05]. At 6, 12, and 24 hours after surgery, there was a significant difference in the Visual Analogue Scale score between the two groups (all P > 0.05). Within 24 hours after surgery, the use of opioid analgesics in the observation group was less than that in the control group [16.00% (4/25) vs. 88.00% (22/25), χ2 = 25.96, P < 0.001]. At 1 hour after surgery, the Bruggemann Comfort Scale score in the observation group was significantly higher than that in the control group [0.00 (0.00, 0.50) vs. 0.00 (0.00, 0.00), Z = 2.08, P < 0.05]. At 6, 12, and 24 hours after surgery, there was no significant difference in the Bruggemann Comfort Scale score between the two groups (all P > 0.05). After surgery, heart rate was significantly decreased in each group compared with before surgery (both P < 0.05). There were no significant differences in respiratory rate and mean arterial pressure between the two groups before and after surgery (both P > 0.05). There were no significant differences in the incidences of postoperative nausea, vomiting, and fever between the two groups (all P > 0.05). Conclusion:The epidural analgesia pump used for uterine artery embolization in the treatment of uterine fibroids has a better analgesic effect and provides more comfort and is safer than the intravenous analgesia pump. The former is worthy of clinical promotion.

Causal analysis on infusion timeout of 5-fluorouracil powder injection infusion pumps and the optimization for dispensing methods / 中国实用护理杂志

Objective:To analyze the cause of infusion timeout of 5-fluorouracil (5-FU) powder injection infusion pumps, and conduct research on the dispensing methods, then provide a basis for clinical dispensing.Methods:The dissolution effect of 5-FU in different solvents were tested in the lab. The effect of different solvents on infusion timeout of infusion pumps, and the factors related to infusion timeout of the pumps were explored by analyzing the clinical data which was collected in Cancer Hospital of Shantou University Medical College from May 20 to July 20, 2020.Results:The dissolving capacity to 5-FU of different solvents sorted by the influence in a descending manner as follows: water for injection> 5% glucose injection (5%GS) >0.9% sodium chloride injection (0.9%NS) . Infusion timeout value of water for injection group (15.03 ± 8.62)% was lower than that of 0.9%NS group (36.78 ± 4.81)%, (0.9%NS+ water for injection) group (22.50 ± 7.22)%, 5%GS group (25.53 ± 6.21)% and (5%GS+ water for injection) group (24.78 ± 4.36)% ( t values were 2.50-5.27, all P<0.05). The timeout value of 0.9%NS group was higher than that of other groups ( t values were 3.65-5.27, all P<0.05). There were differences in infusion timeout between intravenous infusion group (23.07 ± 8.98)% and arterial infusion groups (60.60 ± 58.64)% ( H=10.18, P=0.001). There was a positive correlation between drug concentration and infusion timeout( r=0.29, P=0.013), and a negative correlation between total liquid volume and infusion timeout ( r=-0.59, P<0.01). Infusion timeout of pumps was partly (67.3%) affected by drug concentration, total liquid volume and infusion route. Conclusions:The research shows that infusion timeout of 5-FU powder injection infusion pumps is related to drug concentration, total liquid volume and infusion route. It is suggested that the percentage of water for injection, drug concentration, total liquid volume, and infusion route should be considered when 5-FU powder injection infusion pumps are prepared.

Start-up delay in syringe infusion pumps with different rates and priming techniques of intravenoust sets / Retardo en la puesta en marcha en bombas de infusión de jeringa con diferentes velocidades de infusión y purga del sistema de infusión / Atraso na inicialização em bombas de infusão por seringa com diferentes velocidades de infusão e técnicas de preenchimento do sistema de infusão

ABSTRACT Objective: To investigate infusion pumps start-up delay according to different brands of infusion pumps, flow rates and intravenous sets priming techniques. Method: The experimental study simulated clinical practice under controlled conditions, using a 50 mL syringe with NaCl 0.9% solution, two syringe infusion pumps (A and B), six rates (0.3, 0.5, 1.0, 5, 10 and 20 mL/h), two purging techniques (manually or infusion pump's electronic bolus). Data were analyzed according to mean, standard deviation, Student's t and ANOVA tests (p<0.05). Results: The start-up delay was greater in low rates regardless the priming technique. The electronic bolus increased the infusion pump A accuracy at 0.3mL/h (p=0.010), 0.5 mL/h (p=0.002) and 1.0mL/h (p=0.004). Pump's accuracy in all studied rates and manual IV sets filling was similar. Conclusion: In low infusion rates the start-up delay was greater despite the infusion pump brand and electronic bolus improved pumps accuracy.

RESUMEN Objetivo: El objetivo fue investigar el retraso en la operación de bombas de infusión de acuerdo con diferentes marcas de bombas de infusión, velocidades de infusión y técnicas de purga de lo sistema de infusión. Método: Estudio experimental que simuló la práctica clínica en condiciones controladas con jeringas de 50 mL y solución de NaCl 0,9%, dos bombas de infusión de jeringa (A y B), seis velocidades (0,3; 0,5; 1,0; 5; 10 y 20 mL/h), dos modos de purga (manual o electrónico por la bomba de infusión - bolo). Los datos se analizaron según media, desviación estándar, Test-T y ANOVA (p<0,05). Resultados: El retraso de la operación de las bombas ocurrió en tasas bajas independientemente de la técnica de purga. El modo electrónico aumentó la precisión de la bomba de infusión A en 0,3 mL/h (p=0,010), 0,5 mL/h (p = 0,002) y 1,0 mL/h (p=0,004). Con la técnica manual la precisión fue similar. Conclusión: Los retrasos de operación fueran significantes en bajas velocidades de infusión y el modo electrónico optimizó la precisión.

RESUMO Objetivo: Verificar o atraso de inicialização de bomba de infusão, segundo diferentes marcas de bombas de infusão, velocidades e técnicas de preenchimento do sistema de infusão intravenosa. Método: Estudo experimental que simulou a prática clínica, utilizando seringas de 50 mL com solução de NaCl 0,9%, duas marcas de bombas de infusão por seringa (A e B), seis velocidades (0,3; 0,5; 1,0; 5; 10 e 20 mL/h), dois modos de preenchimento do sistema (manual ou eletrônico pelo modo bolus do equipamento). Os dados foram analisados segundo média, desvio padrão e testes t de Student e ANOVA (p<0,05). Resultados: O atraso na inicialização foi maior em velocidades baixas, independentemente da marca e modo de preenchimento. O preenchimento eletrônico aumentou a acurácia na bomba A em 0,3 mL/h (p=0,010), 0,5 mL/h (p=0,002) e 1,0 mL/h (p=0,004). A acurácia em preenchimento manual foi semelhante. Conclusão: Em baixas velocidades de infusão o atraso de inicialização foi maior e o preenchimento do sistema de infusão pelo modo eletrônico melhorou a acurácia dos equipamentos.

Usability of volumetric infusion pumps in pediatric intensive care / Usabilidad de bombas de infusión volumétrica en cuidados intensivos pediátricos / Usabilidade de bombas de infusão volumétricas em terapia intensiva pediátrica

ABSTRACT Objective: To analyze the usability of two infusion pump models in a Pediatric Intensive Care Unit. Method: This is a cross-sectional study of exploratory descriptive quantitative approach. A task was carried out in a controlled environment using infusion pump with 72 nursing staff members from August to September 2018. The Methodological Guideline for Medical Care Equipment Assessment Studies and the quality model proposed by NBR ISO/IEC 9126-1 were followed. Descriptive statistical analysis was used applying Fisher's exact test, binomial test and Mann-Whitney test. Results: 91.7% of tasks were completed. The infusion pump-2 model was associated (p < 0.001) with operationalization, tasks accomplished with non-conformities, use of a manual calculator (measure effectiveness) and task accomplishment time (measure efficiency). Conclusion: Efficacy and efficiency measures can evidence a better context of usability of IPs and identify interaction failures with the nursing staff to be improved in care practice.

RESUMEN Objetivo: Analizar la usabilidad de dos modelos de bombas de infusión en una Unidad de Cuidados Intensivos Pediátricos. Método: Estudio transversal con abordaje descriptivo exploratorio cuantitativo. Se realizó una tarea en ambiente controlado utilizando la bomba de infusión con 72 integrantes del equipo de enfermería de agosto a septiembre de 2018. Como base, se siguió la guía metodológica para los estudios de evaluación de Equipos de Asistencia Médica y el modelo de calidad en uso propuesto por NBR ISO/IEC 9126-1 Se utilizó análisis estadístico descriptivo, aplicando Test Exacto de Fisher, Test Binomial y Test de Mann-Whitney. Resultados: Hubo 91,7% de tareas completadas. El modelo de bomba de infusión-2 se asoció (p <0,001) con la operatividad, las tareas cumplidas con no conformidades, el uso de la calculadora manual (medida de efectividad) y el tiempo para completar la tarea (medida de eficiencia). Conclusión: Las medidas de eficacia y eficiencia pueden mostrar un mejor contexto de usabilidad de las bombas de infusión e identificar fallas de interacción con el equipo de enfermería para mejorar en la práctica asistencial.

RESUMO Objetivo: Analisar a usabilidade de dois modelos de bomba de infusão em Unidade de Terapia Intensiva Pediátrica. Método: Estudo com delineamento transversal de abordagem quantitativa do tipo descritivo exploratório. Realizou-se em um ambiente controlado uma tarefa utilizando a bomba de infusão com 72 integrantes da equipe de enfermagem no período de agosto a setembro de 2018. Como base, seguiu-se a diretriz metodológica para estudos de avaliação de Equipamentos Médicos-Assistenciais e o modelo de qualidade em uso proposto pela NBR ISO/IEC 9126-1. Utilizou-se a análise estatística descritiva, aplicando o Teste Exato de Fisher, o Teste Binomial e o Teste de Mann-Whitney. Resultados: Constataram-se 91,7% de tarefas cumpridas. O modelo da bomba de infusão-2 apresentou associação (p < 0,001) com a operacionalização, tarefas cumpridas com não conformidades, uso da calculadora manual (medida eficácia) e o tempo para cumprir a tarefa (medida eficiência). Conclusão: Medidas de eficácia e eficiência podem evidenciar um melhor contexto de usabilidade de bombas de infusão e identificar falhas de interação com a equipe de enfermagem a serem aprimoradas na prática assistencial.

Fadiga de alarmes em bombas de infusão no contexto pediátrico: revisão integrativa / Alarm fatigue in infusion pumps in the pediatric context: integrative review / Fatiga de alarma en bombas de infusión en el contexto pediátrico: revisión integrativa

Objetivo: identificar as causas da fadiga de alarmes em estudos de usabilidade de bomba de infusão em terapia intensiva pediátrica. Métodos: Realizou-se uma revisão integrativa nas bases de dados LILACS, SciELO, IBECS, SCOPUS e MEDLINE. Resultados: Foram identificadas 1.164 publicações e selecionados seis estudos primários que emergiram em duas temáticas: compreender as causas dos alarmes da bomba de infusão que constou: biblioteca de fármacos incompleta, limites absolutos e relativos rígidos, falta de protocolo de preparo e administração de medicação, período de férias dos funcionários; e as medidas que podem evitar a fadiga de seus alarmes.Conclusão:falhas na usabilidade de bombas de infusão aumentam os alarmes desnecessários que podem promovem sua fadiga. A utilização segura de bombas de infusão demanda uma equipe que monitore suas práticas e atue promovendo mudanças no contexto de trabalho

Objective: to identify the causes of alarm fatigue in studies of infusion pump usability in pediatric intensive care. Methods: an integrative review was carried out in the LILACS, SciELO, IBECS, SCOPUS and MEDLINE databases. Results: 1,164 publications were identified and six primary studies were selected that emerged in two themes: understanding the causes of the infusion pump alarms that consisted of: incomplete drug library, absolute and strict relative limits, lack of preparation protocol and medication administration, employee vacation period; and measures that can prevent fatigue from your alarms. Conclusion: the causes of alarm fatigue involve low user interaction with the equipment, inadequate work processes and low investment in preventive measures for its occurrence The safe use of infusion pumps requires a team to monitor their practices and act by promoting changes in the work context

Objetivo: identificar las causas de la fatiga de alarma en estudios de usabilidad de bombas de infusión en cuidados intensivos pediátricos. Métodos: se realizó una revisión integradora en las bases de datos LILACS, SciELO, IBECS, SCOPUS y MEDLINE. Resultados: se identificaron 1.164 publicaciones y se seleccionaron seis estudios primarios que surgieron en dos temas: comprender las causas de las alarmas de la bomba de infusión que consistían en: biblioteca de medicamentos incompleta, límites relativos absolutos y estrictos, falta de protocolo de preparación y administración de medicamentos, período de vacaciones de los empleados; y medidas que pueden prevenir la fatiga de sus alarmas. Conclusión: las causas de la fatiga de las alarmas involucran baja interacción del usuario con el equipo, procesos de trabajo inadecuados y baja inversión en medidas preventivas para su ocurrencia. El uso seguro de las bombas de infusión requiere que un equipo monitoree sus prácticas y actúe promoviendo cambios en el contexto de trabajo

Ultrasound combined with X-ray-guided precise implantation of totally implantable access ports in the chest wall / 中国基层医药

Objective:To investigate the success rate, operation time and complications of ultrasound combined with X-ray-guided precise implantation of totally implantable access port (TIAP) in the chest wall.Methods:A total of 623 patients who underwent implantation of totally implantable venous access ports in the chest wall in Meizhou People's Hospital, China between January 2015 and August 2018 were included in this study. In group A ( n = 320), jugular or subclavian access ports were precisely implanted in the chest wall under the guidance of ultrasound combined with X-ray. During the surgery, color Doppler ultrasound was used to guide the puncture and a C-arm machine was used to locate the position of catheter tip. In group B ( n = 303), venous access ports were implanted using the conventional method. Subclavian vein puncture was performed using anatomic landmarks and the depth of catheterization was estimated by experience. The success rate of the first implantation, operation time, and complications (pneumothorax, hemothorax, catheter displacement, poor position of catheter tip, skin infection, and thrombosis) were compared between the two groups. Results:There were no statistical differences in baseline data between the two groups ( P > 0.05). The success rate of the first implantation in the group A was significantly higher than that in the group B [100% (320/320) vs. 93.06% (282/303), χ2 = 22.95, P < 0.01]. The operation time in the group A was significantly shorter than that in the group B [(26.48 ± 5.49) minutes vs. (35.51 ± 14.37) minutes, t = -10.25, P < 0.01]. In group A, 2 patients developed pneumothorax and healed after conservative treatment, 6 patients had thrombosis, and the incidence of complications was 2.5% (8/320). In group B, complications occurred in 67 patients, including pneumothorax in 9 patients, poor catheter tip position in 17 patients, thrombosis in 36 patients, and skin infection in 1 patient, and the incidence of complications was 22.11% (67/303). There was significant difference in the incidence of complications between the two groups ( χ2 = 56.53, P < 0.01). In group B, 6 out of 9 patients developing pneumothorax were healed after closed thoracic drainage, and 4 patients underwent a secondary surgery because of catheter displacement into the internal jugular vein. Conclusion:Precise implantation of venous access ports in the chest wall guided by ultrasound combined with X-ray has the advantages including 100% success rate of first precise implantation, few complications, short operation time, high comfort, safety and efficacy.

Uso da bomba de infusão em terapia intensiva: perspectivas da equipe de enfermagem / Uso de la bomba de infusión en cuidados intensivos: perspectivas del equipo de enfermería / Use of the infusion pump in intensive care: perspectives of the nursing team

Objetivo: analisar as percepções dos profissionais de enfermagem sobre o uso da Bomba de Infusão no seu cotidiano em Terapia Intensiva. Método: estudo descritivo-exploratório de abordagem qualitativa, realizado com 15 profissionais de enfermagem da Unidade de Terapia Intensiva Adulto de um hospital-escola público do Paraná. A coleta de dados ocorreu em junho/2017, por meio de entrevistas semiestruturadas gravadas, pautadas na questão norteadora: fale-me sobre o uso da bomba de infusão no seu cotidiano de trabalho. Aos dados transcritos, empregou-se a Análise de Conteúdo. Resultados: foram pontuados aspectos positivos e negativos acerca do uso da bomba de infusão, além de sugestões gerais ao seu propósito. Considerações Finais: apesar dos entrevistados perceberem a Bomba de Infusão como viabilizadora da assertividade na infusão volêmica, existem desvantagens relacionadas ao sensor de gotas e alarme. Como sugestões de melhorias, referiam necessidade de otimizar o design da Bomba de Infusão, especialmente a programação de alarmes.

Objective: to analyze the perceptions of nursing professionals about the use of the Infusion Pump in their daily lives in Intensive Care. Method: descriptive-exploratory study, with a qualitative approach, conducted with 15 nursing professionals working in the Intensive Care Unit for Adults of a public teaching hospital in Paraná. Data collection took place in June/2017, through recorded semi-structured interviews, based on the guiding question: could tell me about the use of the infusion pump in your daily work? As for the transcribed data, Content Analysis was employed. Results: positive and negative aspects were highlighted regarding the use of the infusion pump, besides general suggestions for its purpose. Final considerations: although the interviewees perceive the Infusion Pump as a viable way for the assertiveness in volemic infusion, there are disadvantages related to the drop and alarm sensor. As for suggestions for improvements, it was mentioned the need to optimize the design of the Infusion Pump, especially the alarm programming.

Objetivo: analizar las percepciones de los profesionales de enfermería sobre el uso de la Bomba de Infusión en su vivir cotidiano en Cuidados Intensivos. Método: estudio descriptivo-exploratorio con enfoque cualitativo, realizado con 15 profesionales de enfermería de la Unidad de Cuidados Intensivos para Adultos de un hospital público de enseñanza en Paraná. La recopilación de datos ocurrió en junio/2017, mediante entrevistas semiestructuradas grabadas, basadas en la pregunta orientadora: ¿podrías contarme sobre el uso de la bomba de infusión en su trabajo cotidiano? Para los datos transcritos, se empleó el Análisis de Contenido. Resultados: se señalaron aspectos positivos y negativos acerca del uso de la bomba de infusión, además de sugerencias generales para su propósito. Consideraciones finales: aunque los entrevistados perciben que la Bomba de Infusión es viable para la asertividad en la infusión volémica, existen desventajas relacionadas con el sensor de gotas y alarma. Como sugerencias de mejoras, se mencionó la necesidad de perfeccionar el design de la Bomba de Infusión, especialmente la programación de alarmas.

Handling errors in conventional and smart pump infusions: A systematic review with meta-analysis / Errores de manejo en la bomba de infusión convencional y smart pump: revisión sistemática con metaanálisis / Erros de manuseio na bomba de infusão convencional e smart pump: revisão sistemática com metanálise

Abstract Objective: To identify the scientific evidence on the frequency of handling errors of conventional and smart pump infusions in intravenous insulin therapy in intensive care units. Method: A systematic review with meta-analysis conducted in the Virtual Health Library, MEDLINE via PubMed, Scopus and Web of Science databases. Articles were assessed regarding the level of evidence by applying the Oxford Center for Evidence-Based Medicine Evidence Scale. Results: Twelve (12) publications were selected which met the eligibility criteria. The programming error rate using the conventional infusion pump ranged from 10% to 40.1%, and the smart pump technology error rate ranged from 0.3 to 14%. The meta-analysis of two studies favored the smart pump in reducing the relative risk of programming errors by 51%. Conclusion: Based on selected articles, the smart pump reduces the risk of programming errors.

Resumen Objetivo: Identificar las evidencias acerca de la frecuencia de errores en el manejo de las bombas de infusión convencional y smart pump en la terapia insulínica intravenosa en unidades de cuidados intensivos. Método: Revisión sistemática con metaanálisis llevada a cabo en las bases de datos Biblioteca Virtual de Saúde, MEDLINE por vía PubMed, Scopus y Web of Science. Los artículos fueron evaluados en cuanto al nivel de evidencia por la aplicación de la Escala de Evidencia del Oxford Centre for Evidence-Based Medicine. Resultados: Se seleccionaron 12 publicaciones que atendieron los criterios de elegibilidad. El índice de errores de programación utilizando la bomba de infusión convencional varió del 10% al 40,1% y en la tecnología smart pump varió del 0,3% al 14%. El metaanálisis de dos estudios fue favorable a la smart pump en la reducción del riesgo relativo de errores de programación en el 51%. Conclusión: Considerando como base los artículos seleccionados, la smart pump reduce el riesgo de errores de programación.

Resumo Objetivo: Identificar as evidências científicas acerca da frequência de erros no manuseio das bombas de infusão convencional e smart pump na terapia insulínica intravenosa em unidades de cuidados intensivos. Método: Revisão sistemática com metanálise realizada nas bases de dados Biblioteca Virtual de Saúde, MEDLINE via PubMed, Scopus e Web of Science. Os artigos foram avaliados quanto ao nível de evidência pela aplicação da Escala de Evidência do Oxford Centre for Evidence-Based Medicine. Resultados: Foram selecionadas 12 publicações que atenderam aos critérios de elegibilidade. A taxa de erros de programação usando a bomba de infusão convencional variou de 10% a 40,1% e na tecnologia smart pump variou de 0,3 a 14%. A metanálise de dois estudos foi favorável a smart pump na redução do risco relativo de erros de programação em 51%. Conclusão: Considerando como base os artigos selecionados, a smart pump reduz o risco de erros de programação.

Multimodal intrathecal therapy for phantom limb pain: a report of 2 cases / Terapia intratecal multimodal para tratamiento de dolor de miembro fantasma: Reporte de dos casos

Abstract Introduction: Phantom limb pain (PLP) is a chronic debilitating condition, frequently observed in amputees. At present, there is no standard treatment, and its optimal management requires a multidisciplinary approach in which minimally invasive treatment should be considered in more complex cases. Objective: To report successful treatment of 2 cases of PLP treated with ziconotide as part of multimodal intrathecal management. Materials and methods: Descriptive, retrospective case report developed in a multimodal pain treatment unit. Results: A total of 2 cases of patients with diagnosis of PLP refractory to medical therapy, treated with intrathecal multimodal therapy, are presented. Their favorable course, with 50% pain reduction, is described. Conclusion: Implantation of infusion systems for administration of intrathecal analgesia with ziconotide at the cervical and supraspinal level proved to be effective in the described cases; this technique should be evaluated in specific trials for the treatment of PLP refractory to other therapies.

Resumen Introducción: El dolor de miembro fantasma es una condición crónica debilitante, frecuentemente observada en pacientes amputados. En la actualidad carece de un estándar de tratamiento. Su óptimo manejo requiere un abordaje multidisciplinario en el que el tratamiento mínimamente invasivo debe ser considerado en los casos más complejos. Objetivo: Reportar el éxito obtenido en dos casos de dolor de miembro fantasma tratados mediante ziconotida, como parte del manejo multimodal intratecal. Materiales y métodos: Se trata de un reporte de casos, descriptivo y retrospectivo, desarrollado en una unidad de tratamiento integral del dolor. Resultados: Se presentan dos casos de pacientes con diagnóstico de dolor de miembro fantasma refractario a tratamiento médico, tratados con terapia multimodal intratecal; se describe su evolución favorable después del inicio de la terapia, con una reducción de dolor del 50%. Conclusiones: La implantación de sistemas de infusión para administración de analgesia intratecal con ziconotida a nivel cervical y supraespinal demostró ser eficaz en los casos descritos; esta técnica debe ser evaluada en ensayos específicos para el tratamiento del dolor de miembro fantasma en miembros superiores, refractario a otras terapias.

Tratamiento de las complicaciones motoras en la enfermedad de Parkinson / Treatment of motor complications in Parkinson's disease

RESUMEN Las fluctuaciones motoras y las discinesias hacen parte de las complicaciones motoras que invariablemente se presentarán con la progresión y avance de la enfermedad de Parkinson. Se estima que el 90 % de los pacientes las padecen después de 10 años de enfermedad. El tratamiento de estas condiciones requiere entender el patrón, las características y el tipo de fluctuaciones o discinesias de cada paciente. En este capítulo se realiza una revisión detallada sobre cada una de estas complicaciones motoras y se muestran los algoritmos para su abordaje y manejo, incluyendo las indicaciones y recomendaciones de las terapias avanzadas disponibles en Colombia, como la cirugía de estimulación cerebral profunda y la apomorfina subcutánea.

SUMMARY Motor fluctuations and dyskinesias are complications that invariably occur with the progression of Parkinson's disease, affecting about 90 % of patients after ten years of disease. The treatment of these conditions requires an understanding of the pattern, features and type of motor fluctuations and dyskinesias in each patient. In this chapter, the characteristics of motor complications are reviewed and the strategies and algorithms for its management are described, including the indications and recommendations of the available advanced therapies in Colombia, such as functional neurosurgery and subcutaneous apomorphine.

El ABC de la analgesia controlada por el paciente / The ABCs of patient-controlled analgesia

Resumen La analgesia controlada por el paciente (PCA, por sus siglas en inglés: patient controlled analgesia) es la administración continua y/o intermitente de analgésicos opioides y no opioides a través de un dispositivo con dosis a demanda y control del paciente. Su mecanismo de acción antinociceptivo tiene efecto en la percepción del control del dolor por el propio paciente, en sinergia, con la acción de los medicamentos. Bajo el concepto de concentración mínima efectiva analgésica, las bombas PCA permiten mantener las concentraciones plasmáticas estables de los fármacos, particularmente de los opioides, disminuyendo la carga de atención al personal de enfermería y la administración de medicamentos «por razón necesaria¼. Las bombas de PCA cuentan con un intervalo de seguridad que impide la sobredosificación por intentos repetitivos de activación por el paciente de las dosis en bolos, y se ha demostrado que brindan mejores resultados en la analgesia durante las primeras 24 horas (nivel de evidencia moderada). Las rutas más utilizadas son la vía intravenosa y la vía epidural. En esta revisión se presentan los pasos básicos para el uso de estos dispositivos, preparación y programación de bolos o infusiones analgésicas, así como los pasos seguros que deben considerarse durante su empleo (visite http://www.painoutmexico.com para obtener el artículo completo y videos).

Abstract Patient-controlled analgesia (PCA) is the continuous and/or intermittent administration of opioid and non-opioid analgesics through a device with on-demand doses and patient control. Its mechanism anti-nociceptive has an effect on the perception of pain controlled by the patient himself, in synergy, with the action of the medications. Under the concept of minimum effective analgesic concentration, PCA pumps allow the stable plasma concentrations of the drugs, particularly opioids, to be maintained, reducing the nursing staff attention and the administration of drugs «for necessary reason¼. PCA pumps have a safety interval that prevents overdosing due to repetitive attempts by the patient to activate bolus and has been shown to provide better analgesia during the first 24 hours (moderate level of evidence). The most commonly routes are the intravenous and the epidural. In this review we present the basic steps for the use of these devices, preparation and programming of boluses or analgesic infusions, as well as safety steps during their use (visit http://www.painoutmexico.com to see the full article and videos).

Adherencia y potenciales eventos adversos prevenidos durante la administración de medicamentos endovenosos empleando bombas de infusión inteligentes en cuatro unidades de cuidados intensivos en Colombia / Adherence and potential adverse events prevented during the administration of intravenous medications using Smart infusion pump in four intensive care units in Colombia

Resumen Introducción: Las bombas de infusión inteligentes, constituyen una herramienta útil para la administración segura de medicamentos endovenosos dado que permiten prevenir potenciales eventos adversos. Objetivo: Evaluar la adherencia y los potenciales eventos adversos prevenidos, durante la administración de medicamentos endovenosos empleando bombas de infusión inteligentes. Metodología: Estudio observacional, realizado en cuatro unidades de cuidados intensivos usando datos del software Hospira MedNetTM. Un análisis descriptivo fue llevado a cabo junto con un análisis bivariado empleando una prueba U de Mann-Whitney, una prueba de Kruskal-Wallis y un test de Bonferroni para evaluar la adherencia y los potenciales eventos adversos prevenidos por año y servicio. Resultados: La adherencia fue del 74,0%, se presentaron 78.299 alertas de seguridad y se previnieron 4,54% (n=16.288) potenciales eventos adversos. Se encontraron diferencias entre el primer y segundo año en la adherencia [Mediana: 69,15 (Q1:64,2-Q3:75,5) Vs Mediana: 84,2(Q1:72,15-Q3:89,05), p<0.001], adherencia a la seguridad [Mediana: 87,1% (Q1:83,05-Q3:91,2) Vs Mediana: 94,05 (Q1:89,95-Q3:96,2), p<0.001] y las ediciones de alertas de limite relativo [Mediana:17,0 (Q1:8,5-Q3:24,5) Vs Mediana: 12,0 (Q1:7,0-Q3:17,5), p=0.013]. La solución salina, la norepinefrina, el lactato de ringer, la piperacilina-tazobactam, la nitroglicerina y la heparina presentaron el mayor número de alertas de seguridad. Conclusión: Se encontró una buena adherencia (uso de la farmacoteca) y adherencia a la seguridad (indicador de uso de la bomba), con una reducción de los potenciales eventos adversos; así el uso de bombas inteligentes podría contribuir en la prevención de potenciales errores durante la administración de medicamentos endovenosos en la unidad de cuidados intensivos.

Abstract Introduction: Smart infusion pumps have become a useful tool for the safe administration of intravenous medications, since they allow the prevention of potential adverse events. Objetive: To assess adherence and potential adverse events prevented during intravenous medication administration using smart infusion pumps. Methods: Observational study, conducted in four intensive care units using data from Hospira MedNetTM software. A descriptive analysis was carried out together with a bivariate analysis using a Mann-Whitney U test, a KruskalWallis test and a Bonferroni test to assess adherence and potential adverse events prevented by year and service. Results: Adherence was 74.0%, 78,299 safety alerts were presented and 4.54% (n = 16,288) potential adverse events were prevented. Differences were found between the first and second year in adherence [Median: 69.15 (Q1: 64.2-Q3:75.5) versus Median: 84.2 (Q1: 72.15-Q3: 89.05), p<0.001]. Likewise safety adherence [Median: 87.1% (Q1: 83.05-Q3: 91.2) versus Median: 94.05 (Q1: 89.95-Q3: 96.2), p<0.001] and the relative limit alert editions [Median: 17.0 (Q1: 8.5-Q3: 24.5) versus Median: 12.0 (Q1: 7.0-Q3: 17.5), p=0.013]. The saline solution, norepinephrine, ringer's lactate, piperacillin-tazobactam, nitroglycerin and heparin presented the highest number of safety alerts. Conclusions: Adequate adherence (use of the drug library) and safety adherence (indicator of pump use) were found, with a reduction in potential adverse events; thus, the use of smart pumps could contribute to the prevention of potential errors during the administration of intravenous medications in the intensive care unit.

Comparison of Operator Workloads Associated with the Single-unit Anyfusion® Pump and the Changeover from a Syringe Pump to an Infusion Pump

Effectiveness of continuous hypertonic saline infusion with an automated infusion pump for decompressive neuroplasty: a randomized clinical trial / 대한통증학회지

BACKGROUND: Hypertonic saline (HS) injections for decompressive neuroplasty (DN) can cause pain. We assessed whether a continuous infusion of HS through an infusion pump would reduce injection-related pain compared with repeated bolus administrations. METHODS: Fifty patients scheduled for DN were randomized to either the bolus injection or the continuous infusion group. After appropriately placing the epidural catheter, 4 mL of 5% NaCl was injected as four boluses of 1 mL each at 15-minute intervals or infused over 1 hour using an infusion pump. The severity of pain induced by HS injection, as measured by the 11-point numerical rating scale (NRS), was the primary outcome. The severity of low back or lower extremity pain, as measured by the 11-point NRS and Oswestry Disability Index (ODI), 3 months following the procedure, was the secondary outcome. RESULTS: Data from 21 patients in the bolus group and 23 in the continuous infusion group were analyzed. No statistically significant difference in injection-related pain was identified between the two groups during the initial HS administration (P = 0.846). However, there was a statistically significant reduction in injection-related pain in the continuous infusion group compared to the bolus injection group from the second assessment onwards (P = 0.001, < 0.001, and < 0.001, respectively). No significant between-group differences in the NRS and ODI scores 3 months post-procedure were noted (P = 0.614 and 0.949, respectively). CONCLUSIONS: Our study suggests that administering HS through a continuous infusion is a useful modality for reducing HS injection-related pain during DN.

Analgesia intravenosa ambulatoria con bombas elastoméricas en pacientes sometidos a cirugía plástica: serie prospectiva de casos / Ambulatory intravenous analgesia using elastomeric pumps in patients undergoing plastic surgery: prospective case series

Abstract Introduction: Cosmetic plastic surgery interventions are usually associated with significant postoperative pain. As they are outpatient procedures, analgesic management is limited mostly to oral medication, resulting in suboptimal pain control, one of the most frequent complaints of patients undergoing these surgical procedures. Elastomeric pumps have been studied for continuous infusion of intravenous analgesics in other types of surgeries associated with significant pain. Objective: The main objective of this study was to evaluate postoperative pain control in adult patients who underwent mammoplasty, abdominoplasty, liposuction, or combined procedures using elastomeric pumps for postoperative analgesic management in continuous intravenous infusion. Materials and methods: A prospective sample of 100 patients who accepted postoperative pain management was collected. Satisfaction was evaluated using a survey, and pain control was assessed on postoperative days 1,3, and 5, and a determination of adverse reactions associated with analgesia using this device was also assessed. Results: Optimal pain control and a satisfaction greater than 90% were observed from the first postoperative day of the intervention. Conclusion: We recommend this analgesic strategy based on evidence of excellent postoperative ambulatory pain control.

Resumen Introducción: La cirugía plástica estética se caracteriza porque generalmente son intervenciones que originan un importante dolor posoperatorio, al ser procedimientos ambulatorios, el manejo analgésico se limita en la mayoría de las ocasiones a medicación vía oral, la que genera un control subóptimo del dolor, siendo una de las quejas más frecuentes de los pacientes sometidos a estas cirugías. Desde hace algún tiempo se han estudiado las bombas elastoméricas para la infusión continua de analgésicos intravenosos, con el propósito de controlar el dolor posoperatorio en otros tipos de cirugías con importante potencial doloroso. Objetivo: El objetivo principal de este estudio fue evaluar el control del dolor posoperatorio en pacientes adultos, quienes se sometieron a mamoplastia, abdominoplastia, liposucción o combinaciones de estas, con el uso de bombas elastoméricas para el manejo analgésico posoperatorio en infusión intravenosa continua. Materiales y métodos: Se recogió una muestra prospectiva de 100 pacientes quienes aceptaron el manejo del dolor posoperatorio, en quienes se evaluó por medio de una encuesta la satisfacción y el control del dolor de los pacientes al día 1, día 3 y día 5 posoperatorio, además si se presentaron reacciones adversas generadas por la analgesia aplicada a través de este dispositivo. Resultados: Se encontró un óptimo control del dolor y una satisfacción mayor del 90% desde el 1° día posoperatorio de la intervención realizada. Conclusiones: Recomendamos esta estrategia analgésica ya que se evidenció un excelente control del dolor posoperatorio ambulatorio.

Manometria anorretal de alta resolução sob cateter de perfusão (MARAR): primeira experiência no Brasil / Water-perfused high-resolution anorectal manometry (hram-wp): the first brazilian study

ABSTRACT BACKGROUND: High resolution anorectal manometry (HRAM-WP) allows more simplified, objective, and uniform data acquisition and interpretation of the test results. OBJECTIVE: To validate a HRAM under water perfusion (Alacer Biomédica) with a 24-channel probe and to compare the results of anorectal manometry with other systems. METHODS: Individuals without critical evacuation disorders were selected. Patients with incontinence, anal surgery, dyssynergia or sphincter injury were excluded. The test was performed with an Alacer Biomédica 24 channel manometry system under water perfusion, with a probe configured with 6 levels of 4 radial channels, separated from each other by 0.8 mm. The mean pressures for the functional channel were determined, in states of rest (RMP), contention effort (CMP) and evacuation effort (EEMP). The pressure extension of the sphincter was also tabulated in cm. The results were compared with those available in recent literature. RESULTS: Fifty patients were studied (20 men; 30 women). Overall, the following results were obtained: the RMP was 76.9±3.0 mmHg, the CMP was 194.2±9.4 mmHg, and EEMP was 88.2±3.7 mmHg. When classified according to the gender, for men: RMP was 72.2±3.0 mmHg, CMP was 229.5±17 mmHg, and EEMP was 91.4±7.0. For women, RMP was 79.8±4.0 mmHg, CMP was 170.7±8, and EEMP was 86.1±4.3 mmHg. The sphincter gauge extension for both genders was 3.1±0.09 cm (men 3.3±0.1; women 3.0±0.1). DISCUSSION: Studying HRAM-WP has become much easier. Non-mobilization of the sensor causes less discomfort and artefacts with a lower assessment time. In this study, small differential values between both sexes during rest were observed, highlighting a greater containment force in men. No difference in sphincter extension was noted. The results of this study are consistent with that of existing reports and with those obtained using solid state probes. CONCLUSION: The perfusion system yielded results similar to that of solid state systems. Further studies to evaluate parameters with respect to pelvic dyssynergia and incontinence need to be conducted. Additionally, to determine if the vector volume can furnish new information in terms of functional and anatomical aspects.

RESUMO CONTEXTO: Através da manometria anorretal de alta resolução (MARAR), a aquisição dos dados e a interpretação do exame tornaram-se mais simplificadas, objetivas e uniformes. OBJETIVO: Validar um sistema de MARAR sob perfusão de água (Alacer Biomédica), com sonda de 24 canais e comparar resultados dos exames de manometria anorretal com outros sistemas em trabalhos já publicados. MÉTODOS: Selecionados indivíduos sem distúrbio evacuatório importante. Excluídos pacientes com incontinência, cirurgia orificial, dissinergia, ou lesão esfincteriana. O exame foi realizado com sistema Alacer Biomédica de manometria sob perfusão de agua de 24 canais, com sonda configurada com 6 níveis de 4 canais radiais, distanciados entre si por 0,8 mm. Estabelecidas as pressões médias para o canal funcional, nos estados de repouso (PMR), no esforço de contenção (PMC) e no esforço evacuatório (PMEE). Também foi tabulada a extensão pressórica do esfíncter em cm. Comparou-se os resultados com os disponíveis em literatura recente. RESULTADOS: Foram estudados 50 pacientes (20 masc; 30 fem). No geral, foram encontrados os seguintes resultados: a PMR foi de 76,9±3,0 mmHg; PMC foi de 194,2±9,4 mmHg e; PMEE foi de 88,2±3,7 mmHg. Quando divididos por sexo: sexo masculino: PMR 72,2±3,0 mmHg; PMC: 229,5±17 mmHg e; PMEE 91,4±7,0. Sexo feminino: PMR 79,8±4,0 mmHg; PMC: 170,7±8; PMEE 86,1±4,3 mmHg. A extensão manométrica para ambos os sexos foi de 3,1±0,09 cm (masc 3,3±0,1; fem 3,0±0,1). DISCUSSÃO: A realização do estudo da MARAR ficou muito facilitada. A não mobilização da sonda provoca menos desconforto e artefatos, com menor tempo de estudo. Em nossa série há valores diferenciais pequenos entre os sexos durante o repouso, destacando-se maior força de contenção no sexo masculino. Não houve diferença para a extensão do esfíncter. Em relação à comparação com os estudos já publicados, mesmo com sondas de solid state, há uma proximidade de valores. CONCLUSÃO: O sistema de perfusão utilizado permitiu reproduzir resultados similares a sistemas solid state. Resta estabelecer parâmetros em casos de dissinergia pélvica, incontinência e esclarecer se o estudo pelo vetor volume pode trazer novas informações nos aspectos funcional e anatômico.

Utilidad del ultrasonido: Relleno de bomba intratecal en el manejo de dolor crónico. Reporte de caso / Usefulness of ultrasound: intrathecal pump refill in the management of chronic pain. A case report

Abstract Intrathecal administration for the treatment of patients with difficult to manage chronic pain represents a therapeutic breakthrough that reduces adverse effects and improves the patient's quality of life. However, the use and refill of infusion pumps entails certain risks. A difficult access to the refill port and the potential for subcutaneous infiltration are rare but potentially fatal complications. The use of ultrasonography as real-time guidance for the localization of the port has been suggested. The case of a patient with a diagnosis of ankylosing spondylitis and chronic pain, with neuroplasticity phenomena in the management of analgesia with opioid intrathecal infusion pump and the need for frequent refill is discussed. An ultrasound-guided static method using coordinates was used for a successful, free of complications refill. The technique described for the refill of intrathecal infusion pumps is a practical and innovative approach which, through adequate training, may reduce the risks and complications during the procedure in patients requiring frequent refills.

Resumen La vía de administración intratecal en el tratamiento de pacientes con dolor crónico de difícil manejo representa un avance terapéutico que disminuye efectos adversos y mejora su calidad de vida. Sin embargo, el uso y recarga de bombas de infusión presenta riesgos. Un acceso difícil al puerto de recarga y la posible infiltración subcutánea son complicaciones infrecuentes, pero potencialmente fatales. El uso de ultrasonografía como guía en tiempo real o para localización del puerto ha sido propuesto. Se presenta el caso de un paciente con diagnóstico de espondilitis anquilosante y dolor crónico con fenómenos de neuroplasticidad en manejo analgésico con bomba de infusión intratecal de opioides y necesidad de recarga frecuente, en quien se aplicó un método estático mediante coordenadas utilizando ultrasonido para guiar la recarga de forma exitosa y sin complicaciones. La técnica descrita para la recarga de bombas de infusión intratecal es una manera práctica e innovadora que, con el entrenamiento adecuado, puede disminuir los riesgos y complicaciones durante el procedimiento en pacientes con requerimiento de recarga frecuente.

Sistema de infusión intratecal implantable para el tratamiento del dolor refractario por cáncer / (Intrathecal drug delivery system for medically refractory cancer pain treatment)

Resumen El cáncer es la segunda causa de muerte en Costa Rica y un alto porcentaje de pacientes con cáncer tiene dolor producto de su enfermedad. Diferentes estrategias permiten ofrecer alivio del dolor en aquellos casos de alta complejidad en los que el manejo médico no cumpla las metas de tratamiento. Se presenta un caso de un paciente con cáncer de esófago y dolor severo por cáncer refractario a manejo médico comprehensivo, por lo cual se ofreció tratamiento con terapia combinada (morfina, ziconotide, ropivacaína), mediante un sistema implantable de analgesia intratecal. Esta estrategia permitió obtener rápidamente un adecuado y sostenido control del dolor asociado a una mejoría de la funcionalidad del paciente. Se discuten los hallazgos clínicos y los estudios de imagen. En este caso la analgesia intratecal demostró ser una opción eficaz para tratar adecuadamente el dolor, en el contexto de un paciente con dolor severo por cáncer refractario a manejo médico comprehensivo. Es necesaria una aproximación multimodal del tratamiento del dolor y considerar esta técnica mínimamente invasiva en casos complejos de dolor por cáncer.

Abstract Cancer is the second cause of death in Costa Rica and a high percentage of cancer patients have pain due to their illness. Different strategies allow offering pain relief in high complexity cases in which medical management does not meet treatment goals. We present an illustrative case of a patient with esophageal cancer and severe cancer related pain refractory to comprehensive medical management. Intrathecal combination therapy (morphine, ziconotide, ropivacaine) was offered through an implantable intrathecal analgesia system. This strategy allowed obtaining quickly an adequate and sustained pain control with an improvement in patient's functional status. Clinical findings and imaging studies are discussed. In this case, intrathecal analgesia proved to be an effective option to adequately treat pain in a patient with severe cancer pain refractory to comprehensive medical management. A multimodal approach to cancer pain management is necessary and this minimally invasive technique should be considered in complex cases of cancer pain.

Consenso de la Asociación Colombiana de Neurología sobre el uso de apomorfina en la enfermedad de Parkinson / Colombian Association of Neurology Consensus on the use of Apomorphine in Parkinson's disease

La apomorfina es un agonista dopa que se viene usando desde hace más 25 años en el tratamiento de la enfermedad de Parkinson avanzada con complicaciones motoras complejas, por lo cual sigue siendo de gran importancia en el tratamiento de esta etapa de la enfermedad. En el siguiente escrito, realizado por el Comité de Movimientos Anormales de la Asociación Colombiana de Neurología, se hace una revisión respecto a la medicación, su eficacia y el papel en el manejo de la enfermedad de Parkinson, así como una comparación entre las diferentes terapias avanzadas disponibles hoy en día. De la misma manera el Comité hace recomendaciones sobre las indicaciones, elección de candidatos y protocolos para el inicio de las diferentes formas de administración (intermitente e infusión continua) para optimizar el uso de esta terapia y facilitar la adherencia al tratamiento. Por otra parte, se revisan los efectos adversos relacionados con la terapia y se hacen recomendaciones sobre el manejo de las mismas, el seguimiento que se debe hacer a los pacientes que reciban apomorfina y las claves en el tratamiento a largo plazo. long term.

Apomorphine is a dopamine agonist that has been used for more than 25 years in the treatment of advanced Parkinson's disease with complex motor complications, becoming an important treatment option for this stage of the disease. In the following document, written by the movement disorders committee of the Colombian Association of Neurology, an extensive review is made about this medication, its efficacy and role in the management of Parkinson's disease as well as a comparison between the different advanced therapies available today. Additionally, recommendations about the indications, election of candidates and protocols for choosing between the different forms of administration (intermittent and continuous infusion) are establish according current evidence in order to help clinicians to optimize the use of this therapy and facilitate adherence to treatment. On the other hand, adverse effects related to the therapy are reviewed and recommendations are made about their management, as well as a protocol to follow-up patients receiving apomorphine and keys in the long term.

Hemolysis risk after packed red blood cells transfusion with infusion pumps / Risco de hemólise após transfusão de concentrado de hemácias com bombas de infusão / Riesgo de hemólisis después de la transfusión de concentrados de glóbulos rojos con bombas de infusión

ABSTRACT Objective: To evaluate the hemolysis biomarkers of packed red blood cells transfused by two different linear peristaltic infusion pumps at two infusion rates. Method: An experimental and randomized study was designed simulating the clinical practice of transfusion. Two linear peristaltic infusion pumps from different manufactures were studied in triplicate at 100 mL/h and 300mL/h infusion rates. The chosen hemolysis biomarkers were total hemoglobin, free hemoglobin, hematocrit, potassium and degree of hemolysis. They were analyzed before and after each infusion. Results: Potassium showed statistically significant variations in all scenarios of the experiment (P<0.010). In a separated analysis, potassium increased mainly at 300mL/h rate (P=0.021) and free hemoglobin had significant variation when comparing infusion pumps from different manufacturers (P=0.026). Although hematocrit, total hemoglobin and degree of hemolysis had increased after infusion, no statistically significance variations were identified. Conclusions: Hemolysis risk induced by a linear peristaltic infusion pump was identified by an increase in free hemoglobin and potassium markers. As the potassium biomarker is often increased in aged packed red blood cells, we do not recommend using them in this scenario. Additional studies should be performed about other markers and using larger samples in order to reinforce the transfusion practice in nursing.

RESUMO Objetivo: avaliar os biomarcadores de hemólise de concentrado de hemácias transfundidos por duas bombas de infusão peristáltica linear distintas, em duas taxas de infusão. Método: estudo experimental randomizado desenhado para simular a prática clínica da transfusão. Duas bombas de infusão peristáltica linear de diferentes fabricantes foram estudadas em triplicata a 100 ml/h e 300 mL/h de infusão. Os biomarcadores de hemólise escolhidos foram hemoglobina total, hemoglobina livre, hematócrito, potássio e grau de hemólise. Eles foram analisados antes e após cada infusão. Resultados: o potássio apresentou variações estatisticamente significativas em todos os cenários do experimento (P < 0,010). Em análise separada, o potássio aumentou principalmente na taxa de 300 mL/h (P = 0,021) e a hemoglobina livre teve uma variação significativa no experimento comparando bombas de infusão de diferentes fabricantes (P = 0,026). Embora o hematócrito, a hemoglobina total e o grau de hemólise tenham aumentado após a infusão, não foram identificadas variações estatisticamente significativas. Conclusões: o risco de hemólise induzido por bombas de infusão peristáltica linear foi identificado com base em um aumento nos marcadores de hemoglobina livre e potássio. Como o biomarcador potássio é frequentemente aumentado em concentrados de hemácias envelhecidos, não se recomenda usá-los nesse cenário e estudos adicionais podem ser realizados. Vale a pena realizar estudos sobre outros marcadores e utilizar amostras maiores para fundamentar a prática de enfermagem transfusional.

RESUMEN Objetivo: evaluar los biomarcadores de hemólisis de concentrados de glóbulos rojos transfundidos por dos bombas de infusión peristálticas lineales diferentes a dos velocidades de infusión. Método: se hizo un estudio experimental y aleatorizado que simula la práctica clínica de la transfusión. Se estudiaron dos bombas de infusión peristálticas lineales de diferentes fabricantes por triplicado a velocidades de infusión de 100 ml/h y 300 ml/h. Los biomarcadores de hemólisis elegidos fueron la hemoglobina total, la hemoglobina libre, el hematocrito, el potasio y el grado de hemólisis. Fueron analizados antes y después de cada infusión. Resultados: El potasio mostró variaciones estadísticamente significativas en todos los escenarios del experimento (P <0.010). En análisis separados, el potasio aumentó principalmente a una tasa de 300 ml/h (P=0.021) y la hemoglobina libre tuvo una variación significativa en un experimento de un fabricante de bomba de infusión (P=0.026). Aunque el hematocrito, la hemoglobina total y el grado de hemólisis aumentaron después de la infusión, no se identificaron variaciones estadísticamente significativas. Conclusiones: el riesgo de hemólisis inducido por una bomba de infusión peristáltica lineal se identificó por un aumento en la hemoglobina libre y los marcadores de potasio. Debido a que el biomarcador de potasio a menudo aumenta en los glóbulos rojos concentrados de edad, no recomendamos utilizarlos en este escenario y se podrían realizar estudios adicionales. Vale la pena realizar estudios sobre otros marcadores y el uso de muestras más grandes para fundamentar la práctica de enfermería de transfusión de sangre.