Standardization and Chemical Characterization of Intravenous Therapy in Adult Patients: A Step Further in Medication Safety
Silvia Manrique-Rodríguez 1 2 3 , Irene Heras-Hidalgo 4 5 , M Sagrario Pernia-López 4 5 6 , Ana Herranz-Alonso 4 5 6 , M Camino Del Río Pisabarro 7 8 , M Belén Suárez-Mier 7 9 , M Antonia Cubero-Pérez 7 10 , Verónica Viera-Rodríguez 7 11 , Noemí Cortés-Rey 7 12 , Elizabeth Lafuente-Cabrero 7 13 , M Carmen Martínez-Ortega 7 14 , Esther Bermejo-López 15 16 , Cristina Díez-Sáenz 17 , Piedad López-Sánchez 6 18 , M Luisa Gaspar-Carreño 6 19 , Rubén Achau-Muñoz 6 19 , Juan F Márquez-Peiró 6 20 , Marta Valera-Rubio 6 21 , Esther Domingo-Chiva 6 22 , Irene Aquerreta-González 6 23 , Ignacio Pellín Ariño 15 24 , M Cruz Martín-Delgado 15 24 , Manuel Herrera-Gutiérrez 15 25 , Federico Gordo-Vidal 15 26 , Pedro Rascado-Sedes 15 27 , Emilio García-Prieto 15 28 , Lucas J Fernández-Sánchez 29 , Sara Fox-Carpentieri 30 , Carlos Lamela-Piteira 6 31 , Luis Guerra-Sánchez 32 , Miguel Jiménez-Aguado 32 , María Sanjurjo-Sáez 4 5 6
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.
CITA DEL ARTÍCULO Drugs R D. 2021 Mar;21(1):39-64. doi: 10.1007/s40268-020-00329-w