IMPLEMENTACIÓN DE BUENAS PRÁCTICAS PARA LA ADMINISTRACIÓN DE AMINAS VASOACTIVAS: UN ESTUDIO CUASI-EXPERIMENTAL

Camerini, Flavia Giron; Silva, Jaqueline Oliveira da; Henrique, Daniele Mendonça; Fassarella, Cintia Silva; Andrade, Karla Biancha Silva; Schutz, Vivian

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Original Article • Texto contexto - enferm. 31 • 2022 • https://doi.org/10.1590/1980-265X-TCE-2022-0086en copiar

IMPLEMENTACIÓN DE BUENAS PRÁCTICAS PARA LA ADMINISTRACIÓN DE AMINAS VASOACTIVAS: UN ESTUDIO CUASI-EXPERIMENTAL

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivo

analizar la implementación de capacitaciones sobre buenas prácticas para la administración de aminas vasoactivas ante la ocurrencia de eventos clínicos indeseables en pacientes de una unidad cardiointensiva.

Método

se trata de un estudio cuasi-experimental (antes y después), realizado en tres etapas en un hospital universitario ubicado en Río de Janeiro, Brasil. En la primera etapa, se realizó una observación sobre la adherencia del equipo a las buenas prácticas en la administración de aminas vasoactivas. En la segunda etapa, se realizó capacitación con el equipo de enfermería para la implementación de las acciones y, en la tercera etapa, se evaluó la adherencia a las buenas prácticas en la administración de aminas vasoactivas. La recolección de datos fue de octubre de 2019 a julio de 2021. Para comparar las diferencias en los grupos pre y post intervención se utilizó la prueba de McNemar y la prueba no paramétrica de Wilcoxon.

Resultados

280 pacientes fueron infundidos con aminas vasoactivas, 97 en la primera etapa (preintervención) y 183 después de la intervención. Las variables relacionadas con la administración de forma exclusiva y la identificación de la bomba de infusión obtuvieron 100% de asertividad. Se identificaron un total de 37 (13,2%) eventos clínicos indeseables relacionados con el uso de aminas vasoactivas, 27 (27,8%) en el grupo control (preintervención) y 10 (5,5%) después de la intervención, evidenciándose una reducción significativa (valor p = 0,0001).

Conclusión

la implementación de la intervención contribuyó significativamente para la reducción de la ocurrencia de eventos clínicos indeseables relacionados con la administración de aminas vasoactivas, contribuyendo para una terapia farmacológica más segura.

DESCRIPTORES
Seguridad del paciente; Fármacos cardiovasculares; Gestión de riesgos; Cuidado de enfermera; Sistemas de medicación en el hospital; Medidas de seguridad; Efectos secundarios y reacciones adversas relacionados con los medicamentos

Variable	Group				Total		p-value
	Control		Post-Intervention		Total
	n	%	n	%	n	%
Exclusive route
yes	97	100	183	100	280	100	1
no	0	0	0	0	0	0	1
Route correctly identified
yes	85	87.6	173	94.5	258	92.1	0.041
no	12	12.4	10	5.5	22	7.9	0.041
Proximal lumen administration
yes	46	47.4	146	79.8	192	68.6	< 0.0001
no	51	52.6	37	20.2	88	31.4	< 0.0001
Pump identified
yes	97	100	183	100	280	100	1
no	0	0	0	0	0	0	1
Validate infusion
yes	97	100	183	100	280	100	1
no	0	0	0	0	0	0	1
Frequency of monitoring vital signs
1h	1	0.5	0	0	1	0.4	< 0.0001
2h	50	51.5	183	100	233	83.2
4h	47	48.5	0	0	47	16.8

Variable	Total		Group				p-value ^*
	Total		Control		Post-Intervention
	n	%	n	%	n	%
Registry of undesirable clinical events
yes	37	13.2	27	27.8	10	5.5	<.001
no	243	86.8	70	72.2	173	94.5
SBP^† > 200 mmHg
yes	6	2.1	4	4.1	2	1.1	<.001
no	274	97.9	93	95.9	181	98.9
SBP^†< 50 mmHg
yes	4	1.4	0	0	4	2.2	< .001
no	276	98.6	97	100	179	97.8
HR^‡ > 150 bpm
yes	26	9.3	23	23.7	3	1.6	<.001
no	254	90.7	74	76.3	180	98.4
HR^‡ < 50 bpm
yes	1	0.4	0	0	1	0.5	<.001
no	279	99.6	97	100	182	99.5

Universidade Federal de Santa Catarina, Programa de Pós Graduação em Enfermagem Campus Universitário Trindade, 88040-970 Florianópolis - Santa Catarina - Brasil, Tel.: (55 48) 3721-4915 / (55 48) 3721-9043 - Florianópolis - SC - Brazil
E-mail: textoecontexto@contato.ufsc.br

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[1] CORRESPONDING AUTHOR
Flavia Giron Camerini fcamerini@gmail.com

Good practices for administering vasoactive amines - Nursing Interventions	Title: nursing interventions for patients using vasoactive drugs (Dobutamine, Dopamine hydrochloride, Nora hemitartrate epinephrine and Vasopressin.
Objective: contribute to improving the quality of care for critically ill patients using vasoactive drugs.	Agents: Nurses and Nursing Technicians.
	Vasoactive drug concept: set of drugs which have significant pharmacodynamic properties that result in great clinical expression, as they can maintain the lives of patients with serious pathologies.
Interventions common to all vasoactive amines
1. Only infuse in an infusion pump and perform strict flow control. 2. Assess the patency of the intravenous catheter every three hours, checking the flow of the infused solution. 3. Perform continuous monitoring of heart rate and oxygen saturation. 4. Check blood pressure every 15 minutes during dose adjustment and every 60 minutes during maintenance dose. 5. Change continuous solutions every 24 hours; prepare solution immediately before completion and perform the exchange quickly. 6. Identify the solution with a label containing: patient’s name; name of the drug, its concentration and quantity; diluting solution, its concentration and quantity; administration route; start date and time; start flow; and name of the professional who prepared it.
Dobutamine, hydrochloride
Indication: is a potent inotropic agent. It is used in chronic low-output heart failure and ventricular failure in the acute phase of myocardial infarction.
Solution for dilution: 5% glucose or 10% glucose or 0.9% sodium chloride or ringer lactate. Initial dose: 2.5 mg/kg/min; Maximum dose: 20mg/kg/min.
1. Always infuse into an intravenous catheter with a large diameter, preferably central. Give preference to the proximal lumen. 2. In the event of using a peripheral intravenous catheter, pay attention to the presence of inflammatory signs at the catheter insertion site. 3. Pay attention to the appearance of arrhythmias, such as supraventricular tachycardia, non-sustained ventricular tachycardia and atrial fibrillation, and assess hemodynamic repercussion (nurse only). 4. Perform strict control of infused and eliminated liquids. 5. Pay attention to signs of hypovolemia: arterial hypotension, tachycardia, low urinary output, cold and moist skin. 6. Be aware of drug incompatibility: it should not be added to solutions containing sodium bicarbonate or other alkaline solutions (for example, aminophylline and phenytoins), hydrocortisone sodium succinate, cefazolin, cefamandole, neutral cephalothin, penicillin, ethacrynic acid and sodium heparin).
Norepinephrine, tartrate
Indication: is a vasoconstrictor agent used in the emergency recovery of blood pressure in acute hypotensive states.
Solution for dilution: 5% glucose. Initial dose: 0.05 to 1mg/kg/min; Maximum dose: 1.5 to 2mg/kg/min.
1. Always infuse into an intravenous catheter with a large diameter, preferably central. Give preference to the proximal lumen. 2. Frequently monitor peripheral perfusion, skin color and temperature. 3. In the event of using a peripheral intravenous catheter, pay attention to the presence of inflammatory signs at the catheter insertion site. 4. Pay attention to the appearance of arrhythmias, such as ventricular tachycardia, ventricular and atrial fibrillation, and assess hemodynamic repercussion (nurse only). 5. Protect from light: use a solution bottle wrapped in a protective cover for photosensitive solutions and appropriate equipment for photosensitive parenteral solutions. 6. Be aware of incompatibility with sodium bicarbonate or other alkaline solutions (aminophylline, phenytoin, etc).
Vasopressin
Indication: potent vasopressor used in septic shock, diabetes insipidus and gastrointestinal bleeding.
Solution for dilution: 5% glucose, 0.9% sodium chloride or ringer lactate. Initial dose: 0.01 UI/min; Maximum dose: 0.04 UI/min.
1. Always infuse into an intravenous catheter with a large diameter, preferably central. Give preference to the proximal lumen. 2. In the event of using a peripheral intravenous catheter, pay attention to the presence of inflammatory signs at the catheter insertion site. 3. Pay attention to the appearance of arrhythmias and signs of water intoxication.	4. Perform strict control of infused and eliminated liquids. 5. Watch out for interactions with demeclocycline, norepinephrine, lithium, heparin, and alcohol. Medications such as carbamazepine, chlorpropamide, clofibrate, urea, fludrocortizone and tricyclic antidepressants increase the effect of vasopressin.