Feasibility and Safety of Peripheral Intravenous Administration of Vasopressor Agents in Resource-limited Settings
, , , y | 07 nov 2020
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Article Category: Research Article
Publicado en línea: 07 nov 2020
Páginas: 210 - 216
Recibido: 09 ene 2020
Aceptado: 22 ago 2020
DOI: https://doi.org/10.2478/jccm-2020-0030
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© 2020 Ajay Padmanaban, Ramesh Venkataraman, Senthilkumar Rajagopal, Dedeepiya Devaprasad, Nagarajan Ramakrishnan, published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Fig. 1
Baseline patient characteristics
| Total no of patients | 122 | |
|---|---|---|
| Male | 66 | |
| Female | 56 | |
| Age | 55(4) years;[ mean(SD)] | |
| BMI | 24.1(4.4); [mean(SD)] | |
| Indications for vasopressor administration | ||
| Septic shock | 89 | |
| Cardiogenic shock | 7 | |
| Stroke/Subarachnoid haemorrhage | 12 | |
| Other | 14 | |
Vasopressor combinations
| Vasopressor combinations used | Number (n) of patients used |
|---|---|
Noradrenaline – Adrenor (Samarth Life sciences, Mumbai, India) | 85 |
Adrenaline- Vasocon (Neon Laboratories, Palghar, India) | 2 |
Dopamine- Domin (Neon Laboratories, Palghar, India) | 2 |
| Noradrenaline + Vasopressin- Cpressin-P (Samarth Life sciences, Mumbai, India) | 29 |
| Noradrenaline + Adrenaline | 4 |
Vasopressor strengths
| Vasopressor | Dilution | Dose |
|---|---|---|
| Noradrenaline Noradrenaline – Adrenor (Samarth Life sciences, Mumbai, India) | Single strength-2mg/48ml NS | 1ml=40 mcg |
| Double strength-4mg /46ml NS | 1ml=80 mcg | |
| Adrenaline Adrenaline- Vasocon (Neon Laboratories, Palghar, India) | Single strength-3mg/47ml NS | 1ml=60 mcg |
| Double strength-6mg /44 ml NS | 1ml=120 mcg | |
| Dopamine Dopamine- Domin (Neon Laboratories, Palghar, India) | 5ml/45ml NS, 5ml=200 mg | 1ml=4000 mcg (4mg) |
| Vasopressin Vasopressin-Cpressin-P (Samarth Life sciences, Mumbai, India) | 20 units in 20 ml NS | 1ml=1 unit |
Infusion nursing standards of practice Infiltration Scale
| Grade | Clinical severity |
|---|---|
| 0 | No symptoms |
| 1 | Skin blanched |
| Oedema <1 inch in any direction | |
| Cool to touch | |
| With or without pain | |
| 2 | Skin blanched |
| Oedema 1-6 inches in any direction | |
| Cool to touch | |
| With or without pain | |
| 3 | Skin blanched, translucent |
| Gross oedema >6 inches in any direction | |
| Cool to touch | |
| Mild–moderate pain | |
| Possible numbness | |
| 4 | Skin blanched, translucentSkintight, leaking |
| Skin discoloured, bruised, swollen gross oedema | |
| >6 inches | |
| Deep pitting tissue oedema | |
| Circulatory impairment | |
| Moderate–severe pain | |
| Infiltration of any amount of blood product, irritant, or vesicant | |
Vasopressor details
| Noradrenaline | Vasopressin | Adrenaline | Dopamine | |
|---|---|---|---|---|
| Number of Patients | 118/122 | 29/122 | 6/122 | 2/122 |
| Duration-median(IQR) | 9 hours (6 – 14) | 4 hours (2.7 –9) | 6 hours (4-10) | 7.5hrs |
| Initial dose-mean(SD) | 5.9(5.5)mcg/min | 1.9(0.2)U/hr | 5.2(1.7)mcg/min | 10mcg/kg/min |
| Maximum dose - mean(SD) | 14.8(8.8)mcg/min | 2 (0.3)U/hr | 10.5(7.8) mcg/min | 10mcg/kg/min |
| Total dose - mean(SD) | 10.6 (7) mcg/min | 1.9(0.25) U/hr | 6.3(2.8) mcg/min | 8.3mcg/kg/min |