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Preparing Drugs for Infusion Via Syringe Pump: A Key Step to Ensure Homogeneous Concentration
Bruno Garrigue1, Yann Dehu2, Fabrice Girault2
1Bruno Garrigue is an anesthesia nurse and head of the prehospital emergency medicine service at Centre Hospitalier Sud-Francilien, Corbeil-Essonnes, France.Yann Dehu is an anesthesia nurse working in a surgical unit and a clinical research associate at Centre Hospitalier Sud-Francilien.Fabrice Girault is a registered nurse working in a prehospital emergency medicine service, Centre Hospitalier Sud-Francilien.Bruno Figadère is a medicinal chemist at Centre Nationale de Recherches Scientifiques (CNRS)/Universite Paris Sud-Faculte de Pharmacie Joint Laboratory, Chatenay-Malabry, France.Karine Leblanc is a chemical engineer at CNRS/Univ Paris Sud-Faculte de Pharmacie Joint Laboratory.Nicolas Briole is an emergency medicine physician at Centre Hospitalier Sud-Francilien.Georges Antoine Capitani is head of the acute care department at Centre Hospitalier Sud-Francilien.Steven Lagadec is a nurse in the prehospital emergency service and a clinical research associate at Centre Hospitalier Sud-Francilien.François-Xavier Laborne is a prehospital emergency practitioner and a methodologist and biostatistician in the clinical research unit of the Centre Hospitalier Sud-Francilien. bruno.garrigue@ch-sud-francilien.fr.
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).