Cost and acceptability of three syringe-pump infusion systems.

The fiscal impact and acceptability of implementing a syringe-pump infusion system at a 900-bed university teaching hospital where the minibag system has been in use is reported. Researchers selected three models of syringe pumps for evaluation: the Bard Harvard Mini-Infuser 150XL, the Becton Dickinson 360 Infuser, and the Strato Stratofuse System. Each pump was evaluated for three weeks on a medical-surgical unit and a hematology-oncology unit. Drugs to be infused were chosen after a literature review to determine which drugs had been successfully infused via syringe pump; 22 formulary medications were selected. Syringes were prepared as singly packaged doses or as doses prepared in bulk and packaged frozen. Control of the syringe pumps and microbore tubing was assigned to the inpatient pharmacy staff. Nurses and pharmacy personnel were apprised of the study and taught how to use the syringe pumps. Time-and-motion studies were performed in the sterile products preparation area, and a cost analysis was done. Nurses preferred syringe pumps over the minibag system because the pumps reduced the nursing time needed to infuse a drug, administered less fluid, provided consistent infusion rates, had alarms, and were relatively easy to use. The time required to prepare syringes did not differ substantially among syringe-pump models. It was estimated that using any of the evaluated pumps in place of the minibag system would save $126,500 during the three-year period 1988-91, primarily because of differences in the cost of disposable items. The syringe-pump infusion system is an acceptable and cost-effective alternative to the minibag system.

Time-motion study of intravenous ranitidine admixtures.

This study determined the total preparation time, cost, and contamination rate associated with preparing 50-mL admixtures of ranitidine 50 mg from each of the following commercial source vials: 50 mg/2 mL unit-dose vial (treatment A), 50 mg/2 mL 10 mL multidose vial (treatment B), and 50 mg/2 mL 40 mL multidose vial (treatment C). The study consisted of two separate phases: phase I extemporaneous compounding and phase II batch manufacturing. Twelve technicians prepared ten admixtures from each source vial during each phase. All admixtures were tested for sterility; bacterial contamination was not observed. Multidose vials saved approximately $197 per 200 admixtures. Drug and personnel costs were reduced when batch manufacturing with 40-mL multidose vials was compared with extemporaneous compounding with unit-dose vials. Our study showed that multidose vials decreased the total preparation time and cost for making ranitidine admixtures during both extemporaneous compounding and batch manufacturing by reducing setup time, preparation time, and drug procurement cost.

The effect of some preservatives used in nasal preparations on the mucus and ciliary components of mucociliary clearance.

Efficient mucociliary clearance is a function of the physical properties of the mucus coupled to appropriately functioning cilia and may be altered by substances affecting ciliary beat frequency (CBF). Therefore the effect of preservatives on CBF was investigated using a photoelectronic technique. Methyl-p-hydroxybenzoate, propyl-p-hydroxybenzoate, chlorbutol and chlorocresol inhibited beat frequency, an effect which was reversible upon rinsing out the first three compounds but not chlorocresol. The effect of chlorhexidine and phenylmercuric borate on CBF was complicated by an interaction with chloride ions in the media used. EDTA did not appear to be ciliotoxic, while the effect of benzalkonium chloride was variable. Thiomersal halted ciliary beating after 40-100 min. Mucociliary clearance may also be affected by an alteration of the physical properties of the mucus layer, therefore the effect of each compound on the rheological properties of purified pig gastric mucus glycoprotein was investigated. None of the preservatives significantly altered the viscoelastic properties of the gel, measured using dynamic techniques.

Fluorescence imaging of CO(2)laser-heated droplets.

Distortion, ejection, shattering, and propulsion of water and ethanol droplets containing Rhodamine 6G dye have been photographed at different time delays after initiation of a CO(2) laser pulse, whichcauses explosive vaporization of the droplets. We have developed a fluorescence imaging technique to photograph the liquid-phase portion of the ejected material and the parent droplet after irradiation by the CO(2) laser pulse.

Time-resolved shadowgraphs of large individual water and ethanol droplets vaporized by a pulsed CO(2) laser.

Carbon dioxide laser-induced explosive vaporization of water and ethanol droplets at high laser fluence has been observed with time-resolved shadowgraphs. The asymmetry seen in the droplet vaporization can be qualitatively explained by comparison to the internal-field intensity distribution. A central green spot observed in the shadowgraph is attributed to the near-field distribution just outside the shadow face of the droplet when the droplet is illuminated by a visible laser. This spot can be used to probe the shape deformation and optical inhomogeneity of the droplet. The energy dependence of the explosive vaporization of water was also studied. Increasing the CO(2) laser fluence increases the rate of explosive vaporization.

Laser-induced breakdown in large transparent water droplets.

Recent experiments on the laser-induced breakdown (LIB) of large transparent liquid droplets are reviewed. A physical model of LIB processes is presented with the aim of integrating the following recent results: (1) the internal and near-field distributions for large transparent spheres; (2) the location of LIB initiation based on spatially resolved plasma emission spectroscopic techniques; (3) spatially resolved but time-averaged density of the plasma plumes and temperature of the atomic species within the plasma; (4) the plasma front propagation velocities inside and outside the droplet; and (5) the fate of the remaining superheated droplet and the expelled material.

Propagation velocity of laser-induced plasma inside and outside a transparent droplet.

The supersonic propagation velocity of the emission front of plasma produced by laser-induced breakdown of a micrometer-sized transparent droplet flowing in a gas was measured with a streak camera at three intensity levels. At low input intensity, the plasma velocities in the gas away from and toward the shadow face were determined. At medium input intensity, the plasma velocities in the gas outside the shadow face and within the liquid (traveling toward the illuminated face) were measured. At high input intensity, the plasma velocities in the gas outside the shadow face, within the liquid, and in the gas outside the illuminated face were deduced.

Explosive vaporization of a large transparent droplet irradiated by a high intensity laser.

Shadowgraph studies of the explosive vaporization of a transparent water droplet after irradiation by a high intensity beam show that dielectric breakdown occurs within the droplet shadow face and generates a dense plasma, which absorbs the laser pulse. The convective forces expel the vapor from the droplet shadow face. We have deduced (1) the vapor propagation velocities, (2) the recoil velocity of the remaining droplet, and (3) the deformation rate of the illuminated face. Droplets are noted to eject fingerlike material from the surface facing the single laser-vaporized droplet when the asymmetrical vapor intercepts the neighboring droplets.

A combined procedure for 99mTc aerosol ventilation and perfusion imaging.

For several years, radioaerosols have been successfully used to provide detailed images of regional ventilation to aid in the differential diagnosis of pulmonary embolism. It has been widely advocated that the ventilation images should follow the perfusion scan and that the amount of aerosol deposited in the patient's lungs should be three times greater than the perfusion dose. We employed an alternative approach which avoided the deposition of an unpredictable amount of aerosol in individual patients. The aerosol study was performed first, and the activity of the microspheres used for the perfusion images was then tailored to the actual amount of aerosol which the patient had retained. This allowed a microsphere/aerosol activity ratio of 10:1 to be readily achieved, thus successfully masking the ventilation pattern by the perfusion activity. The faster biological clearance of 99mTc-DTPA aerosol from the lung fields, as compared to 99mTc-sulphur-colloid aerosol, allowed higher initial activities to be deposited in the lungs, thus enabling a high-resolution collimator to be used. When the perfusion study was delayed by 1 h (one effective half-life for the 99mTc-DTPA aerosol), it was not necessary to increase the perfusion activity required to mask the ventilation image.