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Vol. 33. Issue 3.
Pages 132-140 (July - September 2022)
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Vol. 33. Issue 3.
Pages 132-140 (July - September 2022)
Original article
Identification of potentially irritating intravenous medications
Identificación de medicamentos intravenosos potencialmente irritantes
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S. Ballesteros-Peñaa,
Corresponding author
sendoa.ballesteros@ehu.eus

Corresponding author.
, I. Fernández-Aedob,c, G. Vallejo-De la Hozb,c,d, J. Tønnesenc,e, C. Miguelezc
a Osakidetza, Organización Sanitaria Integrada Bilbao-Basurto, Bilbao, Spain
b Biocruces Bizkaia Health Research Institute, Barakaldo, Vizcaya, Spain
c Universidad del País Vasco/Euskal Herriko Unibertsitatea (UPV/EHU), Leioa, Bizkaia, Spain
d Osakidetza, Organización Sanitaria Integrada Barrualde-Galdakao, Galdakao, Bizkaia, Spain
e Achucarro Basque Center for Neuroscience, Leioa, Bizkaia, Spain
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Tables (3)
Table 1. Osmolarity (mOsm/l), pH and theoretical ability to cause vascular irritation of different intravenous serum therapy drugs.
Table 2. Osmolarity (mOsm/l), pH and theoretical capacity to cause vascular irritation of different intravenous antibiotics.
Table 3. Osmolarity (mOsm/l), pH and theoretical capacity to cause vascular irritation of different intravenous drugs.
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Figures (3)
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Abstract
Aims

To identify commonly used intravenous drugs that may produce endothelial damage.

Methods

An experimental research study was performed using a sample of 62 intravenous drugs commonly used in emergency care, pH and osmolarity were measured. Subsequently, based on these values, the theoretical capacity to cause irritation or endovascular damage was determined and classified as high, moderate, and low.

Results

Samples from 19 drugs for fluid therapy, 21 antibiotics and 22 drugs for intravenous use were studied. Glucose solutions, sodium bicarbonate 1M and mannitol 10% showed a high capacity to cause venous irritation. Vancomycin, ciprofloxacin, amiodarone, haloperidol, and labetalol solution presented a high capacity for irritation based on their acidic pH. The antibiotics, dexketoprofen, diazepam, digoxin, etomidate, phenytoin, levetiracetam and metamizole also showed high osmotic values in their reconstituted or undiluted presentations. Moreover, osmolarity of diazepam, digoxin and phenytoin remained high despite being diluted in 100 ml of saline.

Conclusions

Knowing the pH and osmolarity of intravenous drugs allows their capacity to cause endothelial damage to be assessed. The use of comprehensive tables based on the chemical properties of the drugs can be a useful tool to help prevent chemically-induced phlebitis.

Keywords:
Phlebitis
Vascular endothelium
Irritants
Osmolar concentration
Resumen
Objetivos

Identificar los medicamentos intravenosos de uso común en el ámbito hospitalario con capacidad de producir daño endotelial.

Método

Estudio experimental in vitro. La muestra estuvo formada por 62 medicamentos de uso común en los servicios de urgencias y hospitalización. Las variables estudiadas fueron: osmolaridad y pH. Posteriormente, en base a esos valores, se determinó la capacidad teórica para provocar daño endotelial, clasificándola en alta, moderada y baja.

Resultados

Se analizaron 19 medicamentos para fluidoterapia, 21 antibióticos y 22 medicamentos intravenosos. Las soluciones de glucosa, el bicarbonato 1M y el manitol 10% presentaron una capacidad elevada para provocar irritación venosa. La vancomicina, ciprofloxacino, amiodarona, haloperidol y labetalol mostraron una capacidad irritativa elevada derivada de su pH marcadamente ácido. Los antibióticos, el dexketoprofeno, diazepam, digoxina, etomidato, fenitoína, levetiracepam y metamizol presentaron valores extremos de osmolaridad en su presentación reconstituida o sin diluir y mantuvieron sus valores de tonicidad elevados después de diluirlos en 100 ml de suero salino el diazepam, la digoxina y la fenitoína.

Conclusiones

Conocer el pH y osmolaridad de los medicamentos intravenosos permite evaluar su capacidad para provocar daño endotelial. La creación de tablas comprensivas en base a las propiedades químicas de los medicamentos puede constituir una herramienta útil que contribuya a prevenir la flebitis químicamente inducida.

Palabras clave:
Flebitis
Endotelio vascular
Irritantes
Concentración osmolar

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