Preparing Drugs for Infusion Via Syringe Pump: A Key Step to Ensure Homogeneous Concentration

Abstract

OBJECTIVE Preparation of drug solutions used with electronic syringe infusion pumps plays a crucial role in the delivery of an accurate drug concentration. Is there a correlation between drug concentrations during syringe pump infusion and preparation protocols? METHOD Norepinephrine, insulin, and sufentanil were prepared in 3 different ways: (1) the drug was taken from the vial, then the solvent was added followed by an air bubble, and mixing was performed by turning the syringe top-to-bottom in a 180° shaking movement 5 consecutive times; (2) the drug was taken from the vial, then the solvent was added and not mixed; and (3) the solvent was taken from a stock solution, then the drug was added and not mixed. Concentrations of drugs were determined at different times during administration by reverse-phase high-performance liquid chromatography with ultraviolet detection. All analyses were performed in triplicate and were based on measurement of peak areas. RESULTS With no shaking of the syringe, the concentration of the injected drugs varies widely. In any case, mixing of the syringe contents by turning the syringe in a top-to-bottom 180° shaking movement 5 times with an air bubble would ensure administration of the drug at a constant concentration. CONCLUSIONS Without mixing, the concentrations of all drug solutions varied widely when administered via an electronic syringe infusion pump. Mixing syringe contents should be made part of the compulsory curriculum for administering medications at all levels of medical education. (Critical Care Nurse. 2016;36[4]:36-45)

Evaluation of the importance of mixing during preparation of antibiotic infusions

“…The conflicting results with regard to drug variations may be partially explained by clinical and methodological heterogeneity of these studies. In contrast to our study that focused on antibiotic infusions in infusion bags, previous studies mainly focused on electrolyte solutions or syringe preparations and did not take normal handling into account [ 4 – 7 , 14 , 15 ]. However, in line with our findings, a study of Layne et al, which examined acetylcysteine infusions, showed no significant difference between the concentrations at the beginning and end of infusions when omitting the mixing step [ 16 ].…”

“…Many studies, mainly performed with concentrated electrolytes, show that omitting this step leads to inhomogeneous infusions and usually high concentrations in the first period of discharge, which subsequently may lead to patient harm, e.g. cardiac arrest after fast administration of potassium chloride [ 4 – 7 , 14 , 15 ]. Another issue that could arise with varying drug concentrations during infusion is that patients may receive an incomplete and unknown dose when flushing after administration is omitted [ 12 , 13 ].…”

Prevalence and determinants of intravenous admixture preparation errors: A prospective observational study in a university hospital

“…This is not the case for all medications and all container types. For instance, concentrated electrolytes, such as potassium chloride, may have serious consequences [47][48][49][50][51][52].…”