Factores asociados a la duración del hemofiltro en técnicas continuas de depuración extracorpórea en el paciente ingresado en cuidados intensivos / Factors associated with haemofilter duration in continuous extracorporeal clearance techniques in intensive care unit patients

Objetivos: Determinar la vida media de los hemofiltros en el paciente crítico ingresado en la unidad de cuidados intensivos y los principales factores asociados a su duración.Metodología:Estudio descriptivo observacional transversal, realizado en una Unidad de Cuidados Intensivos de adultos polivalente. Se estudiaron los hemofiltros colocados en 67 pacientes mayores de 18 años, entre enero y noviembre de 2019. Variables: edad, sexo, peso, unidad de ingreso, velocidad de flujo sanguíneo, fracción de filtrado, débito horario, anticoagulación del sistema, tiempo de tromboplastina activada (TTPA), indicación médica de la terapia, causa de la retirada, localización del catéter, hora de inicio y finalización de la terapia.Resultados:La edad media de los pacientes fue de 62,66 años (±9,95), 81 (71,64%) hombres. Se analizaron un total de 238 hemofiltros con una vida media de 26,28 horas (±22,8). El 80,1 % de los catéteres fueron femorales, el 19% yugulares y el 0,8% subclavios. Se empleó como terapia de anticoagulación, heparina sódica en un 45,8%, citratos en el 20,2% y en un 34% no se utilizó anticoagulación. La velocidad media de flujo sanguíneo fue de 190,08 ml/min (±53,48). Se encontró relación estadística entre las variables flujo sanguíneo (rs=0,208; p=0,001), localización del catéter y duración del hemofiltro (p=0,03).Conclusiones:La vida media del hemofiltro fue de 26 horas. La velocidad del flujo sanguíneo y localización del catéter son factores que repercuten en la duración del hemofiltro. (AU)

Objectives: To determine the half-life of haemofilters in critically ill patients admitted to the intensive care unit (ICU) and the main factors associated with their duration.Methodology:Cross-sectional observational descriptive study conducted in a polyvalent adult intensive care unit. The haemofilters placed in 67 patients over 18 years of age between January and November 2019 were studied. Variables: age, sex, weight, admission unit, blood flow velocity, filtration fraction, hourly debit, system anticoagulation, activated thromboplastin time (APTT), medical indication for therapy, cause of withdrawal, catheter location, start and end time of therapy.Results:The mean age of the patients was 62.66 years (±9.95), 81 (71.64%) men. A total of 238 haemofilters with a mean lifetime of 26.28 hours (±22.8) were analysed. Femoral catheters accounted for 80.1 %, jugular catheters for 19 % and subclavian catheters for 0.8 %. Sodium heparin was used as anticoagulation therapy in 45.8 %, citrates in 20.2 % and no anticoagulation in 34 %. Mean blood flow velocity was 190.08 ml/min (±53.48). A statistical relationship was found between the variables blood flow (rs=0.208; p=0.001), catheter location and haemofilter duration (p=0.03).Conclusions:The half-life of the haemofilter was 26 hours. Blood flow velocity and catheter location are factors that affect the duration of the haemofilter. (AU)

Actuaciones ante sucesos adversos: Cuidados enfermeros en la rotura del catéter venoso central / Procedure adverse events: Nursing care in central venous catheter fracture

En la unidad de cuidados intensivos (UCI) existen muchos factores que pueden propiciar la aparición de sucesos adversos, estando relcionados con la administracion de farmacos es un alto porcentaje, estando relcionados con la administracion de farmacos es un alto porcentaje relacionados con la administración de fármacos. La tomografía axial computarizada es una prueba diagnóstica habitual en el paciente crítico. Para mejorar la visualización de tejidos blandos se utiliza contraste. El contraste es una medicación y la enfermera es la responsable de su correcta administración. El manejo del paciente crítico es complejo. El equipo de UCI y radiología, comparten la responsabilidad de la asistencia y seguridad del paciente durante el traslado y realización de las pruebas con contraste. La Organización Mundial de la Salud recomienda, en sus estrategias para la seguridad del paciente, analizar los errores y aprender de los mismos. Por ello, decidimos investigar las causas del suceso adverso, ocurrido con categoría de gravedad E a un paciente que ingresó en la UCI por un shock séptico de origen abdominal. Se realizó tomografía axial computarizada abdominal con contraste el cual se inyectó por un catéter venoso central. El contraste no apareció en la imagen. ¿Qué ocurrió? El análisis causal permitió entender los factores desencadenantes del evento. Se elaboró un plan de cuidados y un algoritmo para que no volviera a suceder, cuyos objetivos fueron: la mejora de conocimientos, habilidades y la promoción de actitudes favorables hacia la seguridad del paciente, actuando en todos los niveles de prevención primaria, secundaria y terciaria

In a intensive care unit (ICU) there are many factors that can lead to the occurrence of adverse events. A high percentage of these events are associated with the administration of drugs. Diagnostic tests, such as computed tomography, is common in critically ill patients and technique can be performed with injection of contrast agent to enhance the visualization of soft tissue. The contrast is a medication and the nurse is responsible for its proper administration. The management of the critically ill patient is complex. ICU team and radiology shares responsibility for the care and safety of the patient safety during the transfer and performing tests with contrast. The World Health Organisation patient safety strategies, recommends analysing errors and learning from them. Therefore, it was decided to investigate the causes of the category E severity adverse events that occurred in a patient who was admitted to the ICU for septic shock of abdominal origin. An abdominal computed tomography was performed with contrast which was injected through a central venous catheter. The contrast did not appear in the image. What happened? Causal analysis helped to understand what triggered the event. A care plan and an algorithm were drafted to prevent it from happening again, with the following objectives: improving knowledge, skills and promoting positive attitudes towards patient safety, working at primary, secondary and tertiary care levels

[Procedure adverse events: nursing care in central venous catheter fracture]. / Actuaciones ante sucesos adversos: Cuidados enfermeros en la rotura del catéter venoso central.

In a intensive care unit (ICU) there are many factors that can lead to the occurrence of adverse events. A high percentage of these events are associated with the administration of drugs. Diagnostic tests, such as computed tomography, is common in critically ill patients and technique can be performed with injection of contrast agent to enhance the visualization of soft tissue. The contrast is a medication and the nurse is responsible for its proper administration. The management of the critically ill patient is complex. ICU team and radiology shares responsibility for the care and safety of the patient safety during the transfer and performing tests with contrast. The World Health Organisation patient safety strategies, recommends analysing errors and learning from them. Therefore, it was decided to investigate the causes of the category E severity adverse events that occurred in a patient who was admitted to the ICU for septic shock of abdominal origin. An abdominal computed tomography was performed with contrast which was injected through a central venous catheter. The contrast did not appear in the image. What happened? Causal analysis helped to understand what triggered the event. A care plan and an algorithm were drafted to prevent it from happening again, with the following objectives: improving knowledge, skills and promoting positive attitudes towards patient safety, working at primary, secondary and tertiary care levels.

Compatibilidad física de la amiodarona en perfusión continua / Physical compatibility of amiodarone in continuous infusion

Objetivo. Determinar la compatibilidad física de la amiodarona administrada en «Y» con fármacos en perfusión continua con el fin de asegurar su estabilidad y garantizar una administración segura para el paciente. Método. Estudio experimental in vitro. Se determinó la compatibilidad física de la amiodarona con los fármacos más usados en la unidad de cuidados intensivos en perfusión continua, simulando las mismas condiciones que en la práctica diaria: envase, diluyente, temperatura ambiental y luz fluorescente. Todas las muestras se evaluaron mediante inspección visual, observando formación de color, turbidez, precipitación o formación de gas; medición del pH y lectura de las absorbancias a dos longitudes de onda: 450nm y 620nm para detectar cambios de color, turbidez y precipitación respectivamente. Se consideraron compatibles las mezclas que no presentaron cambios físicos, variabilidad del pH <0,50 y del rango espectral <0,010. Resultados. Se realizaron un total de 39 muestras: 14 simples, 13 dobles, 6 triples y 6 cuádruples, que se examinaron a diferentes intervalos de tiempo: 0, 15, 30, 60 y 120min. Las mezclas incompatibles presentaron cambios visuales inmediatos y valores de absorbancias superiores a 0,010nm. No hubo cambios significativos de pH durante el estudio. Conclusiones. La amiodarona es físicamente compatible con cisatracurio, esmolol, haloperidol, insulina, midazolam, morfina, nimodipino, nitroglicerina y urapidil e incompatible con el bicarbonato, furosemida, heparina y tiopental (AU)

Objective. To determine the physical compatibility of amiodarone administered in Y-site with other continuous infusion drugs, in order to ensure stability and safe delivery to the patient. Method. Experimental in vitro study. We determined the physical compatibility of amiodarone with drugs commonly used in the intensive care unit as a continuous infusion, simulating the same conditions as in daily practice: container, solvent, temperature and fluorescent light. All samples were evaluated by visual observation procedures, looking for colour changes, turbidity, precipitation or gas formation, pH measurement and spectrophotometer absorption at wavelengths: 450nm and 620nm to detect colour changes, cloudiness and precipitation, respectively. Compatible mixtures were considered as those that showed no physical changes, variability in pH <0.50 and the spectral range <0.010. Results. We analysed 39 samples: 14 single, 13 doubles, 6 triples and 6 quadruples, which were examined at different time intervals: 0, 15, 30, 60 and 120min. Non-compatible mixtures showed immediate visual changes and higher absorbance values of 0.010nm. There were no significant changes in pH during the study. Conclusions. Amiodarone is physically compatible with cisatracurium haloperidol, insulin, midazolam, morphine, nimodipine, nitroglycerin and urapidil and incompatible with bicarbonate, furosemide, heparin and thiopental (AU)

[Physical compatibility of amiodarone in continuous infusion]. / Compatibilidad física de la amiodarona en perfusión continua.

OBJECTIVE: To determine the physical compatibility of amiodarone administered in Y-site with other continuous infusion drugs, in order to ensure stability and safe delivery to the patient. METHOD: Experimental in vitro study. We determined the physical compatibility of amiodarone with drugs commonly used in the intensive care unit as a continuous infusion, simulating the same conditions as in daily practice: container, solvent, temperature and fluorescent light. All samples were evaluated by visual observation procedures, looking for colour changes, turbidity, precipitation or gas formation, pH measurement and spectrophotometer absorption at wavelengths: 450 nm and 620 nm to detect colour changes, cloudiness and precipitation, respectively. Compatible mixtures were considered as those that showed no physical changes, variability in pH < 0.50 and the spectral range < 0.010. RESULTS: We analysed 39 samples: 14 single, 13 doubles, 6 triples and 6 quadruples, which were examined at different time intervals: 0, 15, 30, 60 and 120 min. Non-compatible mixtures showed immediate visual changes and higher absorbance values of 0.010 nm. There were no significant changes in pH during the study. CONCLUSIONS: Amiodarone is physically compatible with cisatracurium haloperidol, insulin, midazolam, morphine, nimodipine, nitroglycerin and urapidil and incompatible with bicarbonate, furosemide, heparin and thiopental.