1
|
Castro-Olmo F, Morales-Fernández P, Alcaide-Martín M, Fernández-Puntero B, Quintana-Díaz M, Aceña-Gil V. Minimizar el volumen de descarte para la extracción de muestras sanguíneas en los pacientes críticos: ¿es factible? ENFERMERIA INTENSIVA 2023. [DOI: 10.1016/j.enfi.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
|
2
|
Castro-Olmo FJ, Morales-Fernández P, Alcaide-Martín MJ, Fernández-Puntero B, Quintana-Díaz M, Aceña-Gil V. Is minimising waste volume for drawing blood samples in critically ill patients feasible? ENFERMERIA INTENSIVA 2023; 34:19-26. [PMID: 36774248 DOI: 10.1016/j.enfie.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 06/07/2022] [Indexed: 02/11/2023]
Abstract
INTRODUCTION Drawing blood samples through a central venous catheter (CVC) is a customary practice in Intensive Care Units (ICUs). It is indicated to discard a volume of waste blood to avoid interference in the results. AIM To determine whether a lower discard volume for obtaining blood samples from temporary CVCs placed into the internal jugular, femoral or subclavian vein offers valid results. METHOD A quasi-experimental prospective cross-sectional study for which sixty-five patients of over 18 years of age in ICUs, who had been fitted with a triple lumen central venous catheter, were recruited over a period of eight months. Two consecutive blood samples were extracted with tubes for biochemistry, coagulation and hemogram from each patient from the distal lumen. The first sample was obtained with a discarded waste of 1.5 ml from a total extracted volume of 10.2 ml, similar to the usual waste in our ambit (10 ml). Subsequently the second sample was obtained. The paired t-test was used to analyse the data. The Bland-Altman plot and intraclass correlation coefficient (ICC) were used to measure the agreement between methods. The reference change value (RCV) was established as the admissible limit of variation between the pairs of samples. RESULTS A total of 65 sample pairs were drawn (intervention-control). The paired t-test found statistically significant differences with a significance level of α = .05 for chlorine (-.536; .012); prothrombin time (-.092; .019) and prothrombin activity (.284; 1.375).The ICC was greater than .9 in all the variables and the limit determined for the RCV was not surpassed by any value. CONCLUSIONS The results show the reliability of the blood samples drawn with a discard volume of 1.5 ml.
Collapse
Affiliation(s)
- F J Castro-Olmo
- Unidad de Cirugía Plástica, Reparadora y Quemados, Hospital Universitario La Paz, Madrid, Spain.
| | - P Morales-Fernández
- Unidad de Cirugía Plástica, Reparadora y Quemados, Hospital Universitario La Paz, Madrid, Spain
| | | | | | - M Quintana-Díaz
- Unidad de Quemados Críticos, Hospital Universitario La Paz, Madrid, Spain
| | - V Aceña-Gil
- Data Science Laboratory (DSLAB), Universidad Rey Juan Carlos, Móstoles, Madrid, Spain
| |
Collapse
|
3
|
Peck Palmer OM, Dasgupta A. Review of the Preanalytical Errors That Impact Therapeutic Drug Monitoring. Ther Drug Monit 2021; 43:595-608. [PMID: 33928931 DOI: 10.1097/ftd.0000000000000901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 03/06/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Preanalytical errors comprise the majority of testing errors experienced by clinical laboratories and significantly impact the accuracy of therapeutic drug monitoring (TDM). METHODS Specific preanalytical factors in sample timing, collection, transport, processing, and storage that lead to errors in TDM were reviewed. We performed a literature search using several scientific databases including PubMed, ScienceDirect, Scopus, Web of Science, and ResearchGate for human studies published in the English language from January 1980 to February 2021, reporting on TDM and the preanalytical phase. RESULTS Blood collection errors (ie, wrong anticoagulant/clot activator used, via an intravenous line, incorrect time after dosing) delay testing, cause inaccurate results, and adversely impact patient care. Blood collected in lithium heparin tubes instead of heparin sodium tubes produce supertoxic lithium concentrations, which can compromise care. Specimens collected in serum separator gel tubes cause falsely decreased concentrations due to passive absorption into the gel when samples are not processed and analyzed quickly. Dried blood spots are popular for TDM as they are minimally invasive, allowing for self-sampling and direct shipping to a clinical laboratory using regular mail. However, blood collection techniques, such as trauma to the collection site, filter paper fragility, and hematocrit (Hct) bias, can adversely affect the accuracy of the results. Volumetric absorptive microsampling is a potential alternative to dried blood spot that offers fast, volume-fixed sampling, low pain tolerance, and is not susceptible to Hct concentrations. CONCLUSIONS The identification of preanalytical factors that may negatively impact TDM is critical. Developing workflows that can standardize TDM practices, align appropriate timing and blood collection techniques, and specimen processing will eliminate errors.
Collapse
Affiliation(s)
- Octavia M Peck Palmer
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; and
| | - Amitava Dasgupta
- Department of Pathology and Laboratory Medicine, University of Texas McGovern Medical School at Houston, Texas
| |
Collapse
|
4
|
Lalthanthuami HT, Kumari MJ, Venkateswaran R, Lakshmi PR, Ramamoorthy L. Performance of 3 mL versus 5 mL Discarded Volume for Blood Sampling from Central Venous Access Device. J Lab Physicians 2021; 13:112-117. [PMID: 34483554 PMCID: PMC8409120 DOI: 10.1055/s-0041-1726669] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Background Central venous access devices (CVAD) are an essential part of safe practices in critical care, which enable effective venous access and help in avoiding repeated venipuncture. Discard method is widely practiced for blood sampling. A single occasion of blood sampling may cause minimal blood loss; however, the cumulative volume sequential sampling may become clinically significant. The study aims to reduce diagnostic blood loss, ensuring that the subsequent blood sample is not diluted or contaminated by residual intraluminal fluid. Patients and Methods Within-subjects comparative design was adopted for 64 adult patients in the medical intensive care unit of a tertiary hospital. Two blood samples, using 3 mL and 5 mL discarded volume methods, were collected from each patient. Six serum parameters were measured on each of the paired samples and compared. Statistical Analysis Used Paired t -test and Wilcoxon signed rank test were used for comparing the two methods. Bland-Altman plot analysis and intraclass correlation were used for clinically meaningful analysis. Results When tested for fixed bias, there is no statistically significant difference between the methods. Potassium and creatinine levels showed significant proportional bias. The agreement limits of sodium, potassium, creatinine, and direct bilirubin were outside the clinically accepted interval, but the proportion of samples outside these intervals was less than 10%. All serum parameters showed excellent reliability, except for sodium which demonstrated good reliability. Conclusions The practice of discarding 3 mL of blood for discard method is suggested, instead of the standard 5 mL to reduce iatrogenic blood loss. Thus, nurses in critical care are uniquely positioned to limit the diagnostic blood loss while obtaining blood samples.
Collapse
Affiliation(s)
- H T Lalthanthuami
- Department of Medical Surgical Nursing, College of Nursing, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - M J Kumari
- College of Nursing, JIPMER, Puducherry, India
| | | | - P R Lakshmi
- Department of Pharmacy, JIPMER, Puducherry, India
| | | |
Collapse
|
5
|
Rosengarten L, Camara C. A guide to central venous access devices in children. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2020; 29:S6-S14. [PMID: 37243306 DOI: 10.12968/bjon.2020.29.14.s6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Central venous access devices (CVADs) are commonly used in the care of children both in the short term and long term. Health professionals providing care for children who have CVADs in place are required to have a clear understanding of the benefits and risks associated with their use. This article introduces the different types of CVADs commonly used in paediatrics and provides step-by-step guidance on the use and care of these devices.
Collapse
Affiliation(s)
- Leah Rosengarten
- Lecturer, Children's Nursing, Department of Health and Life Sciences, University of Northumbria, Newcastle
| | - Claire Camara
- Graduate Tutor, Children's Nursing, Department of Health and Life Sciences, University of Northumbria, Newcastle
| |
Collapse
|
6
|
Holland J, Peralta RM, Moss RL, Feane K, Uprichard J. A single-centre review of iatrogenic anaemia in adult intensive care. Transfus Med 2020; 30:196-200. [PMID: 32115814 DOI: 10.1111/tme.12674] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 01/26/2020] [Accepted: 02/13/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVES (a) To quantify the volume of diagnostic blood loss (DBL) and evaluate its impact on intensive care unit (ICU) patients, (b) examine the correlation between severity of disease and DBL and (c) identify potentially vulnerable patient subgroups. BACKGROUND Iatrogenic anaemia is an important problem amongst ICU patients, with significant daily DBL. METHODS A single-centre observational cohort study was conducted at St George's Hospital, London, cardiac and general ICU. Forty patients were included in the study. Variables measured were volume of blood collected and discarded on a daily basis, Acute Physiology and Chronic Health Evaluation (APACHE) II score, frequency of phlebotomy, haemoglobin concentration before and after admission to ICU, reason for admission and complications developed in ICU. RESULTS Mean (SD) total volume drawn per patient per day over 4 days was 86.3 mL (19.58). Nearly 30% of the total blood taken was discarded. There was a strong positive correlation between patients admitted because of sepsis and volume of DBL (P < .01), APACHE II score and volume taken (P = .01), patients who developed respiratory failure requiring ventilation and volume taken (P < .01) and patients who had received a blood transfusion and volume taken (P < .01). Haemoglobin concentration on discharge was negatively associated with DBL volume (P < .01). CONCLUSION High volumes of blood were taken and discarded from the study population, possibly reflecting the fact that there are no guidelines for ICU staff in terms of the amount of blood that needs to be withdrawn in order to "prime" access lines.
Collapse
Affiliation(s)
- James Holland
- Foundation Training Programme, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Rita M Peralta
- The Centre for Haemostasis and Thrombosis, St Georges University Hospitals NHS Foundation Trust, London, UK
| | - Rachel L Moss
- Department of Laboratory Medicine, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Kelly Feane
- Department of Transfusion Medicine, St Georges University Hospitals NHS Foundation Trust, London, UK
| | - James Uprichard
- The Centre for Haemostasis and Thrombosis, St Georges University Hospitals NHS Foundation Trust, London, UK.,Department of Transfusion Medicine, St Georges University Hospitals NHS Foundation Trust, London, UK
| |
Collapse
|
7
|
McBride C, Miller-Hoover S, Proudfoot JA. A Standard Push-Pull Protocol for Waste-Free Sampling in the Pediatric Intensive Care Unit. JOURNAL OF INFUSION NURSING 2018; 41:189-197. [PMID: 29659467 PMCID: PMC6214664 DOI: 10.1097/nan.0000000000000279] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Blood sampling is a major source of blood loss in the pediatric intensive care unit (PICU). Blood-sparing sampling techniques such as the push-pull method can significantly reduce sampling-related blood loss and protect patients from anemia and blood transfusions. The push-pull method is supported by research evidence for central venous catheter (CVC) sampling, but research protocols differ and not all CVCs and laboratory tests have been studied. A standard push-pull protocol for the PICU was developed, implemented, and evaluated in this evidence-based practice project. Results show that the protocol can be used safely and reliably as a standard waste-free sampling method in the PICU.
Collapse
Affiliation(s)
- Clare McBride
- Oregon Health and Science University, Doernbecher Children's Hospital, Portland, Oregon (Ms McBride); Rady Children's Hospital, San Diego, California (Dr Miller-Hoover); and University of California at San Diego, Altman Clinical and Translational Research Institute, San Diego, California (Mr Proudfoot). Clare McBride, BSN, RN, CCRN, is a pediatric intensive care and cardiac nurse at Oregon Health and Science University's Doernbecher Children's Hospital. She previously worked at Rady Children's Hospital in San Diego and presented this evidence-based practice project at the American Association of Critical Care Nurses' annual teaching conference. Suzan Miller-Hoover, DNP, RN, CCNS, CCRN-K, has been in the nursing profession for more than 35 years. An experienced national speaker and peer-reviewed author, Dr Miller-Hoover is passionate about evidence-based best practice and pediatrics. James A. Proudfoot, MSc, is a senior statistician at the University of California at San Diego, Altman Clinical and Translational Research Institute. He has consulted on numerous clinical trials and is a coauthor of more than 25 articles
| | | | | |
Collapse
|
8
|
Errington J, Malik G, Evans J, Baston J, Parry A, Price L, Johnstone H, Peters S, Oram V, Howe K, Whiteley E, Tunnacliffe J, Veal GJ. Investigating the Experiences of Childhood Cancer Patients and Parents Participating in Optional Nontherapeutic Clinical Research Studies in the UK. Pediatr Blood Cancer 2016; 63:1193-7. [PMID: 26928983 PMCID: PMC5031198 DOI: 10.1002/pbc.25960] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 02/04/2016] [Accepted: 02/04/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND While the majority of childhood cancer clinical trials are treatment related, additional optional research investigations may be carried out that do not directly impact on treatment. It is essential that these studies are conducted ethically and that the experiences of families participating in these studies are as positive as possible. METHODS A questionnaire study was carried out to investigate the key factors that influence why families choose to participate in optional nontherapeutic research studies, the level of understanding of the trials involved, and the experiences of participation. RESULTS A total of 100 participants from six UK centers were studied; 77 parents, 10 patients >16 years, and 13 patients aged 8-15 years. Ninety-seven percent of parents and 90% of patients felt that information provided prior to study consent was of the right length, with 52% of parents and 65% of patients fully understanding the information provided. Seventy-four percent of parents participated in research studies in order to "do something important", while 74% of patients participated "to help medical staff". Encouragingly, <5% of participants felt that their clinical care would be negatively affected if they did not participate. Positive aspects of participation included a perception of increased attention from medical staff. Negative aspects included spending longer periods in hospital and the requirement for additional blood samples. Ninety-six percent of parents and 87% of patients would participate in future studies. CONCLUSIONS The study provides an insight into the views of childhood cancer patients and their parents participating in nontherapeutic clinical research studies. Overwhelmingly, the findings suggest that participation is seen as a positive experience.
Collapse
Affiliation(s)
- Julie Errington
- Northern Institute for Cancer ResearchNewcastle UniversityNewcastle upon TyneUK
| | - Ghada Malik
- Northern Institute for Cancer ResearchNewcastle UniversityNewcastle upon TyneUK
| | - Julie Evans
- Pediatric Oncology and HaematologyLeeds General InfirmaryLeedsUK
| | - Jenny Baston
- Pediatric Oncology and HaematologyLeeds General InfirmaryLeedsUK
| | - Annie Parry
- Clinical Trials UnitGreat North Children's HospitalNewcastle upon TyneUK
| | - Lisa Price
- Clinical Trials UnitGreat North Children's HospitalNewcastle upon TyneUK
| | - Hina Johnstone
- Clinical Trials UnitGreat North Children's HospitalNewcastle upon TyneUK
| | - Selena Peters
- Institute for Child Life and HealthBristol UniversityBristolUK
| | - Victoria Oram
- Institute for Child Life and HealthBristol UniversityBristolUK
| | | | | | | | - Gareth J. Veal
- Northern Institute for Cancer ResearchNewcastle UniversityNewcastle upon TyneUK
| |
Collapse
|
9
|
Villalta-García P, López-Herránz M, Mazo-Pascual S, Honrubia-Fernández T, Jáñez-Escalada L, Fernández-Pérez C. Reliability of blood test results in samples obtained using a 2-mL discard volume from the proximal lumen of a triple-lumen central venous catheter in the critically ill patient. Nurs Crit Care 2015; 22:298-304. [PMID: 26487571 DOI: 10.1111/nicc.12220] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 07/22/2015] [Accepted: 09/01/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Intensive care patients require a high frequency of blood testing, which results in a significant amount of blood loss. When blood is obtained from a central venous catheter (CVC), a large volume is usually discarded to obtain an unaltered sample for testing. AIM To determine the reliability of complete blood test results in blood samples obtained from the proximal lumen of a triple-lumen CVC using a 2-mL discard volume DESIGN: Observational study with the prospective collection of data METHODS: The subjects enrolled were all patients with a subclavian triple-lumen CVC, older than 17 years and consecutively admitted to intensive care over a 2-year period. In each of the 54 participants, one blood sample was drawn from the proximal lumen of the catheter, discarding 1·61 mL of blood plus 0·39 mL of catheter deadspace (2 mL) and without interrupting infusion in the middle and distal lumens. A second sample was then obtained by direct venous puncture. The reliability of blood test results was determined by comparing sets of variables recorded for the two sampling methods through intraclass correlation coefficients in the Bland-Altman method. RESULTS Inter-method reliability for the variables examined was excellent, >0·75; range (0·868-0·998). Mean differences between the two sample types for the variables most often determined in critically ill patients were leukocytes: 0·200 × 103 /µL, 95% confidence interval (CI) (0·025 to 0·375); erythrocytes: 0·045 × 106 /uL, 95% CI (-0·003 to 0·094); sodium: 0·074 mEq/L, 95% CI (-0·369 to 0·517); potassium: -0·002mEq/L, 95% CI (-0·065 to 0·061) and glucose: 2·426 mg/dL, 95% CI (0·498-4·354). CONCLUSIONS The sampling method proposed minimizes blood loss while offering reliable blood test results. RELEVANCE TO CLINICAL PRACTICE The main benefit of the method proposed is reduced blood loss, improving the care of a critically ill patient.
Collapse
Affiliation(s)
| | - Marta López-Herránz
- Faculty of Nursing, Physiotherapy and Podology, Universidad Complutense de Madrid, Madrid, Spain
| | | | | | | | - Cristina Fernández-Pérez
- Preventive Medicine and Public Health, Unit of Clinical Methodology and Epidemiology, Preventive Medicine Service, Institute of Health Research of the Hospital Clínico de San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| |
Collapse
|
10
|
Winokur EJ, Pai D, Rutledge DN, Vogel K, Al-Majid S, Marshall C, Sheikewitz P. Blood Culture Accuracy: Discards From Central Venous Catheters in Pediatric Oncology Patients in the Emergency Department. J Emerg Nurs 2014; 40:323-9. [DOI: 10.1016/j.jen.2013.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Revised: 03/15/2013] [Accepted: 04/16/2013] [Indexed: 10/26/2022]
|
11
|
Krischke M, Boddy AV, Boos J. Sources of preanalytical error in pharmacokinetic analyses - focus on intravenous drug administration and collection of blood samples. Expert Opin Drug Metab Toxicol 2014; 10:825-38. [PMID: 24738965 DOI: 10.1517/17425255.2014.907273] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Pharmacokinetic (PK) studies for long-established drugs are generally performed outside the well-standardized settings of pharmaceutical industry trials. Instead, such studies are usually performed within daily clinical practice of hospitals. AREAS COVERED This article describes aspects of intravenous (i.v.) drug administration and blood sampling that contribute to potential sources of preanalytical errors for PK investigations. Parameters that bias determination of start and end time of i.v. infusions, as well as consistent rate of drug delivery, are discussed. Causes for drug loss in the infusion device, including adsorption and insufficient flushing, are outlined. The advantages and disadvantages of different blood sampling techniques are reviewed, with an emphasis on pediatric studies. EXPERT OPINION For PK studies that are integrated into the general hospital routine, a variety of potential sources of error exist. Potential pitfalls depend on the specific drug and trial characteristics and they must be anticipated and discussed in advance. Working procedures need to be developed that address the anticipated problems and in detail describe procedures that need compliance between bed and bench.
Collapse
Affiliation(s)
- Miriam Krischke
- University Hospital Muenster, Centre for Clinical Trials (ZKS) , Von-Esmarch-Straße 62, 48149 Muenster , Germany +49 251 83 57104 ; +49 251 57026 ;
| | | | | |
Collapse
|
12
|
Venipuncture Versus Peripheral Catheter: Do Infusions Alter Laboratory Results? J Emerg Nurs 2014; 40:20-6. [DOI: 10.1016/j.jen.2012.03.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Revised: 02/10/2012] [Accepted: 03/21/2012] [Indexed: 11/23/2022]
|
13
|
Braune S, Grunze M, Straub A, Jung F. Are there sufficient standards for the in vitro hemocompatibility testing of biomaterials? Biointerphases 2013; 8:33. [PMID: 24706143 DOI: 10.1186/1559-4106-8-33] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 11/06/2013] [Indexed: 11/10/2022] Open
Affiliation(s)
- Steffen Braune
- Institute of Biomaterial Science and Berlin-Brandenburg Center for Regenerative Therapies, Helmholtz-Zentrum Geesthacht, Kantstrasse 55, Teltow, 14513, Germany,
| | | | | | | |
Collapse
|
14
|
Mendez SJ. Evidence-Based Practice for Obtaining Blood Specimens From a Central Venous Access Device. Oncol Nurs Forum 2012; 39:247-51. [DOI: 10.1188/12.onf.247-251] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
15
|
Minimization of the preanalytical error in plasma samples for pharmacokinetic analyses and therapeutic drug monitoring--using doxorubicin as an example. Ther Drug Monit 2012; 33:766-71. [PMID: 22105595 DOI: 10.1097/ftd.0b013e31823aa8ab] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND There are many sources of variability in plasma samples drawn for pharmacokinetic analyses or therapeutic drug monitoring. In this article, methods are proposed on how to prevent sample dilution (Part I) and contamination effects (Part II) in plasma samples, using doxorubicin as an example. METHODS Experiments were performed in the laboratory setting to identify factors that could influence plasma samples in clinical practice. In part I, it was hypothesized that saline solution left in a catheter could lead to a dilution of samples drawn through this catheter. The impact of 2 different sampling techniques, the "discard method" and the "push-pull method", was examined. In part II, an infusion system was filled with a 1 mg/mL solution of doxorubicin. After rinsing the system with increasing volumes of saline solution, the drug concentration of the fluid left in the system was analyzed. Furthermore, plasma samples were drawn through the drug administration catheter, and the contamination of these samples with doxorubicin left in the catheter was measured. RESULTS In part I, a discard volume of plasma equal to 4 dead volumes of the sampling line was necessary to avoid dilution of a sample taken from a port or double-lumen catheter filled with saline solution ("discard method"). Pulling up and down the same volume through the catheter 5 times ("push-pull method") was proved to be an alternative with no need to discard blood. In part II, after rinsing the infusion system with a volume of saline solution corresponding to 4 dead volumes of the system and after discarding a volume of plasma corresponding to 4 sampling line volumes, the doxorubicin contamination in the samples was negligibly small. CONCLUSIONS Under the described conditions, the push-pull method delivered the same results as the discard method to prevent sample dilution. To avoid contamination in plasma samples, development of standardized sampling procedures seems to be essential and feasible.
Collapse
|
16
|
Cicolini G, Simonetti V, Di Nicola M, Palma E. Comparison of blood samples values by direct venipuncture and Central Venous Catheters with 5 or 10 ml wasted blood. J Clin Nurs 2011; 21:281-4. [DOI: 10.1111/j.1365-2702.2011.03988.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
17
|
Double-lumen central venous port catheters: simultaneous application for chemotherapy and parenteral nutrition in cancer patients. J Vasc Access 2011; 11:335-41. [PMID: 20954131 DOI: 10.5301/jva.2010.5812] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2010] [Indexed: 12/26/2022] Open
Abstract
PURPOSE This study was designed to evaluate the clinical benefit of low-profile double-lumen port catheters in patients receiving simultaneous chemotherapy and parenteral nutrition (PN). Potential advantages, complications, and the durations of simultaneous and single use of the catheter were assessed. METHODS At a university teaching hospital, 10 patients received a double-lumen port catheter (5 men, 5 women; mean age 61.5 ± 12 years). All port implantations were performed under ultrasonographic and fluoroscopic guidance in the radiologic interventional suite. Procedure-related immediate, early, and late complications were recorded until removal of the device, patient's death, or completion of follow-up period. Application times and durations for chemotherapy or PN were determined. RESULTS No immediate complications were observed. First use of the port system for chemotherapy was within 12 days (± 25 days, range 0-84 days) and within 17 hours (± 22 hours, range 0-72 hours) for PN on average. During the application of PN, no delay or interruption of chemotherapy was observed. The port catheter was used for the simultaneous application of chemotherapy and PN for a total of 1,216 hours. One port catheter was removed after 30 days due to suspected port infection. CONCLUSION Central venous double-lumen port systems as a therapeutic option in patients requiring chemotherapy and PN can increase safety during those simultaneous applications, while offering improved patient comfort.
Collapse
|