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PubMed1990

An economic evaluation of transdermal glyceryl trinitrate in the prevention of intravenous infusion failure.

A common cause of peripheral intravenous infusion failure is due to the patient developing phlebitis or extravasation. Recent clinical trials indicate that the use of transdermal glyceryl trinitrate (GTN patches) can reduce the incidence of infusion failure and hence the costs of re-infusion. In this study we conduct an economic evaluation of this new pharmaceutical application to determine whether the use of such patches results in hospital resource cost savings. Time-to-first infusion failure probabilities from a placebo-controlled trial are used to model the sequential failure problem as a Markov process. Using estimated staff and materials costs for first and subsequent infusions, we calculate the expected cost per infused patient to time t for treatment and control groups. Using this simple comparative cost method, results indicate that the net impact on hospital resources from patch usage is dependent upon the total required length of infusion time. Analysis of infusion time thresholds indicates that for patients requiring long-term (t greater than 50 hours) periods of infusion the use of patches is likely to generate resource savings. We conclude that to realize such resource savings clinical decisions to infuse with GTN patches should incorporate the prior probability that the total required length of infusion time exceeds 50 hours.

Administration, Cutaneous↗
PubMed1999

Pulmonary vascular pressures of strenuously exercising Thoroughbreds during intravenous infusion of nitroglycerin.

OBJECTIVE: To determine whether intravenous infusion of nitroglycerin would modify pulmonary arterial, capillary, or venous hypertension in strenuously exercising Thoroughbreds. ANIMALS: 5 healthy Thoroughbred horses. PROCEDURE: Right atrial, right ventricular, and pulmonary vascular pressures were measured. Each horse was used in a control treatment (not medicated) and a nitroglycerin infusion (20 microg/kg of body weight/min) at rest and during exercise on a treadmill. Sequence of treatments was randomized for each horse, and treatments were separated by a 7-day interval. Galloping at 14.2 m/s on a 5% uphill grade elicited maximal heart rate (mean +/- SEM, 212 +/- 2 beats/min) and could not be sustained for > 90 seconds. Nitroglycerin dosage was selected, because maximal pulmonary and systemic hemodynamic effects of i.v. nitroglycerin were elicited at 5 microg/kg/min and increasing the dosage to 20 microg/kg/min did not cause adverse effects. RESULTS: In the control treatment, exercise performed at maximal heart rate resulted in a significant increase in right atrial as well as pulmonary arterial, capillary, and wedge pressures. Nitroglycerin infusion in standing horses significantly decreased right atrial and pulmonary vascular pressures, whereas heart rate increased. Exercise in nitroglycerin-infused horses also resulted in a significant increase in right atrial as well as pulmonary arterial, capillary, and wedge pressures, and these values were not significantly different from data for the control treatment. All horses experienced exercise-induced pulmonary hemorrhage for both treatments. CONCLUSIONS AND CLINICAL RELEVANCE: I.v. administration of nitroglycerin does not modify exercise-induced pulmonary hypertension and is unlikely to affect the incidence or severity of exercise-induced pulmonary hemorrhage in Thoroughbreds.

Animals↗
PubMed1976

Changes in urinary water and electrolyte excretion in sodium-loaded sheep in response to intravenous infusion of arginine vasopressin.

Mature sheep receiving supplements of sodium chloride into the rumen were given intravenous infusions of arginine vasopressin at rates varying from 4-6-23 pmol/min (2-10 mU/min). Infusion of the hormone led to an increase in urine flow and to increases in the amounts of sodium and chloride excreted, the effect on flow was, however, the greater so that the osmolality of the urine fell during the infusions. In sheep given intravenous infusions of a hypertonic sodium chloride solution addition of vasopressin to the infusate led to the formation of a larger volume of urine containing a higher proportion of the infused salt load compared to when the salt solution alone was given. As before the effect on flow was the greater and hence the osmolality of the urine was lower when the hormone was given. In other experiments intravenous infusion of a hypertonic sodium chloride solution at rates providing 2-8 mmol NaCl/min led to increases in urine flow and increases in sodium and chloride excretion, the size of these increases being proportional to infusion rate. Plasma vasopressin levels markedly increased during these infusions, the levels seen being similar to those seen in sheep given vasopressin in amounts which increased both urine flow and electrolyte excretion. This suggests that during hypertonic salt loading vasopressin probably contributes directly to the increases in urine flow and the increases in electrolyte excretion which are seen. Further evidence in support of this was obtained in experiments in which a greater natriuretic response was seen in sheep given a hypertonic sodium chloride solution into the carotid artery as opposed to the given a hypertonic sodium chloride solution into the carotid artery as opposed to the jugular vein and where it was shown that plasma vasopressin levels were indeed higher when the solution was given into the artery.

Angiotensin II↗
PubMed1990

Bolus or intravenous infusion of ranitidine: effects on gastric pH and acid secretion. A comparison of relative efficacy and cost.

STUDY OBJECTIVE: To compare the effects of intravenous bolus injection of ranitidine, continuous intravenous infusion of ranitidine, and placebo on gastric pH, acid secretion, and plasma ranitidine concentration during a 24-hour period, and to determine by survey the use, delivery methods, and costs of histamine H2-receptor antagonists in intensive care units. DESIGN: Double-blind, Latin-square randomized, prospective measurement of the gastric pH, acid output, and plasma ranitidine concentration over 24 hours in response to six treatment regimens in 12 patients with inactive duodenal ulcer. Eight regional hospitals were surveyed to obtain information on the use of histamine H2-receptor antagonists. INTERVENTIONS: Gastric acid secretion, pH, and plasma ranitidine were monitored for 24 hours on six separate days in response to placebo, intravenous bolus injection of ranitidine (50 mg every 8 hours and 75 mg every 12 hours), and continuous intravenous infusion of ranitidine (75, 150, and 300 mg every 24 hours). MEASUREMENTS AND MAIN RESULTS: Intravenous infusions were significantly more effective than bolus injections. After bolus injections, hourly gastric pH values fluctuated widely, from 7.6 to 1.6, whereas during continuous infusion of 150 mg and 300 mg, hourly pH values were 3.8 or greater. The gastric pH was greater than 4.0 in 75% +/- 5% and 83% +/- 6% of determinations done during continuous intravenous infusion of 150 mg and 300 mg, respectively. Fluctuations in the plasma ranitidine concentration corresponded with changes in gastric pH and acid secretion. Histamine H2-receptor antagonists were prescribed for about 75% of patients in intensive care units and were most commonly administered by bolus rather than infusion (5:1); the cost was approximately +40 per day less by infusion. CONCLUSIONS: On the basis of both efficacy and cost, intermittent bolus injections should be discontinued and replaced by continuous intravenous infusion in hospitalized patients requiring treatment with histamine H2-receptor antagonists. If ranitidine is used, either 150 mg or 300 mg administered as a 24-hour continuous infusion is most effective.

Adult↗
PubMedDate not supplied

Tolerance of healthy adult males in intravenous infusion of cetiedil, a vasoerythroactive drug.

The intravenous infusion of cetiedil to a group of ten male volunteers elicited atropine-like side effects on salivation, bronchomotor tone and visual accommodation. With repeated infusions of cetiedil, the incidence as well as the duration of the side effects were reduced significantly, indicating the development of tolerance. Since normal subjects can tolerate repeated intravenous infusions of cetiedil, the clinical investigation of this drug in sickle cell disease can proceed, including those patients suffering from vasoocclusive crises.

Adult↗
PubMed1981

Acetyl glyceryl ether phosphorylcholine. Intravascular alterations following intravenous infusion into the baboon.

The intravenous infusion of 1-O-hexadecyl/octadecyl-2-acetyl-sn-glyceryl-3-phosphorylcholine (AGEPC) in baboons (28 micrograms per kg.) induced acute, but reversible, thrombocytopenia and neutropenia and the intravascular release of platelet factor 4 and thromboxane B2. Maximal depression of circulating platelets and neutrophils occurred within 30 seconds after AGEPC infusion and was accompanied by significant elevations in plasma platelet factor 4 and thromboxane B2 levels (p less than 0.02). Hematocrit values increased after AGEPC infusion, but this increase was delayed relative to the other intravascular alterations, i.e., maximal hematocrit values occurred at 10 to 20 minutes after AGEPC infusion.. The thrombocytopenia induced by AGEPC was reversed within 2 to 3 minutes; in contrast, circulating neutrophils did not return to preinfusion levels until 30 minutes after AGEPC infusion. Plasma platelet factor 4 and thromboxane B2 elevations gradually decreased and returned to preinfusion levels within 30 to 60 minutes. The deacetylated derivative of AGEPC, lyso-glyceryl ether phosphorylcholine, had no effect when similarly infused into baboons. These studies demonstrate that the intravenous administration of AGEPC into baboons initiated significant but reversible intravascular alterations; thus, this unusual acetylated alkyl phosphoglyceride may be an important mediator of inflammation in primates, including man.

Animals↗
PubMed1980

Diuretic effect of intraventricular and intravenous infusions of noradrenaline in conscious sheep.

Infusion of noradrenaline at rates between 32-160 nmol.min-1 for 30 min into one lateral cerebral ventricle of conscious sheep caused a diuresis which was accompanied by negative solute-free water reabsorption and which lasted for 90-120 min. The range of noradrenaline infusion rates used reflects differences between individual animals in the rate of infusion necessry to cause diuresis. Intracerebroventricular (ICV) infusion of noradrenaline at half the diuretic rate caused no significant changes in urine flow. The diuresis induced by ICV noradrenaline infusion was prevented by concurrent ICV administration of the alpha-adrenergic antagonist, phentolamine, but was not prevented by concurrent ICV administration of the beta antagonist, propranolol, or by concurrent intravenous infusion of phentolamine. Intravenous infusion of noradrenaline at rates that were diuretic by ICV infusion caused a diuresis of approximately 30 min duration which coincided with the period of intravenous noradrenaline infusion. This diuresis was prevented by concurrent intravenous infusion of phentolamine. These results were interpreted as indicating that the higher rates of ICV infusion of noradrenaline caused the prolonged water diuresis by acting at a site in the brain and, thereby, inhibiting the release of endogenous vasopressin. ICV infusion of noradrenaline at all rates was followed by a reduction in mean arterial blood pressure and pulse pressure with variable changes in heart rate and by depression of the rates of renal clearance of PAH, potassium and total solute.

Animals↗
PubMed1979

Prolongation of pancuronium-induced neuromuscular blockade by intravenous infusion of nitroglycerin.

Based upon clinical observation of undue prolongation of pancuronium-induced blockade in the presence of intravenous infusion of nitroglycerin, neuromuscular blockades produced by pancuronium, succinylcholine and d-tubocurarine were studied in 51 cats using the sciatic-gastrocnemius nerve-muscle preparation. Pancuronium-induced blockade was found to be significantly prolonged (P less than 0.1) in the presence of a nitroglycerin infusion of 1 microgram/kg/min (65 vs. 127 min). Less, but still significant, prolongation occurred when nitroglycerin, 0.5 microgram/kg/min, was infused. The intravenous infusion of nitroglycerin must be started prior to the pancuronium injection for the block to be prolonged. Neuromuscular blocks produced by succinylcholine and d-tubocurarine were not altered by nitroglycerin. In experiments using the isolated rat diaphragm preparation, the depth of pancuronium-induced block was found not to be changed by nitroglycerin, suggesting an effect of nitroglycerin on the process of recovery from blockade. These findings indicate a selective pancuronium-nitroglycerin interaction.

Animals↗
PubMed1983

Persistent reduction in left ventricular asynergy in patients with acute myocardial infarction by intravenous infusion of nitroglycerin.

Intravenous nitroglycerin (NG) infusion in patients with acute myocardial infarction (AMI) has been shown to improve left ventricular function and myocardial perfusion and to decrease ischemic injury and creatine kinase (CK) indexes of infarct size. To determine whether early NG infusions in patients with AMI decreases the extent of left ventricular asynergy, we used two-dimensional echocardiography to measure asynergic segments (akinesis and/or dyskinesis) at four serial short-axis levels from base to apex (mitral, M; chordal, C; midpapillary, MP; low papillary, LP) in 22 patients with a first anterior AMI. Patients were randomized between infusions of NG (n = 11) or 5% dextrose in water (controls, n = 11) within 5.6 hr after the onset of pain. NG infusion rates were titrated to lower mean arterial pressure to an average level of 7% below control (but not below 80 mm Hg) and were maintained at this level for the duration of the infusions (39 hr). After NG, left ventricular function improved as left ventricular filling pressure decreased (p less than .005), and sigma ST on precordial ST segment mapping decreased (p less than .001). These parameters did not change in control subjects. Computed CK infarct size was smaller in the NG group than in the control group (p less than .05). Before the infusions, the mean extent of left ventricular asynergy (% left ventricular circumference) were similar in both groups: M, 18% vs 21%; C, 22% vs 23%; MP, 26% vs 24%; LP, 32% vs 29%. In addition, the computed total left ventricular asynergy (% surface area) was also similar for these two groups before therapy (25% vs 25%). There was no change in left ventricular asynergy from pretreatment values by 1 hr and 10 days among control subjects: M, 18% vs 18% vs 17%; C, 22% vs 22%; MP, 26% vs 26% vs 22%; LP, 32% vs 33% vs 33%; total 25% vs 25% vs 24% (multiple measures analysis of variance). In contrast, there was a significant decrease (p less than .001) in left ventricular asynergy from pretreatment values by 1 hr and 10 days with NG: M, 21% vs 10% vs 8%; C, 23% vs 12% vs 10%; MP, 24% vs 13% vs 9%; LP, 29% vs 14% vs 10%; total, 25% vs 12% vs 9%.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1995

Dose proportional pharmacokinetics of alprostadil (prostaglandin E1) in healthy volunteers following intravenous infusion.

Prostaglandin E1 (PGE1) (30, 60, 120 micrograms) was administered by intravenous infusion over a 120 min period in an open, three way randomized, cross-over study to 12 healthy male volunteers. For the evaluation of PGE1, PGE0 and 15-keto-PGE0, blood samples were drawn prior to, during and after the infusion. Analytical measurements were performed by gas chromatography/negative ion chemical ionization triple stage quadruple mass spectrometry, a highly specific and sensitive GC/MS/MS-method. During intravenous infusion of 30, 60 and 120 micrograms PGE1, endogenous plasma PGE1 concentrations increased from 1.7 +/- 0.8 to 4.2 +/- 1.1, 6.7 +/- 1.0 and 11.0 +/- 1.9 pg ml-1 respectively. PGE0 plasma concentrations increased from endogenous levels of 1.3 +/- 1.0 pg ml-1 to 7.6 +/- 2.1, 14.1 +/- 3.7 and 28.0 +/- 3.0 pg ml-1 respectively, whilst 15-keto-PGE0 plasma concentrations increased from endogenous levels of 10.2 +/- 13.9 pg ml-1 to 99.3 +/- 27.9, 190.4 +/- 52.5 and 357.2 +/- 72.6 pg ml-1 respectively. Within the dose range of 30-120 micrograms PGE1 2 h-1 there was a linear increase of Cmax and AUC with the dose. The results of the analysis of variance after baseline and dose-correction show a 90% confidence interval in the bioequivalence acceptance range of 80 to 125%.

Adult↗
PubMed1983

Intravenous infusion of L-isomers of phenylalanine and tryptophan stimulate gastric acid secretion at physiologic plasma concentrations in normal subjects and after parietal cell vagotomy.

To determine whether intravenous infusion of individual amino acids stimulated gastric acid secretion in man, graded doses of phenylalanine, tryptophan, glycine, alanine, histidine, and NaCl control were infused on separate days in nine healthy subjects. Intravenous infusion of phenylalanine and tryptophan significantly stimulated gastric acid secretion to 50 and 52%, respectively, of the acid secretory response to intragastric peptone. Intravenous alanine and histidine were without effect, whereas glycine produced a slight response. Serum gastrin concentrations did not significantly change during intravenous amino acid infusion, except in response to 0.1 M phenylalanine. However, the increase in serum gastrin occurred 2 h after acid secretion had significantly increased in response to the 0.025 M phenylalanine infusion. Plasma amino acid concentrations were measured during intravenous amino acid infusion and in response to a steak meal in five of the subjects. At a time when acid secretion was significantly increased during intravenous infusion of phenylalanine and tryptophan, plasma amino acids were similar to, or less than, that observed after the steak meal, suggesting that circulating levels of these three amino acids have a physiologic effect on gastric secretion in man. Intravenous infusion of a combination of graded doses of phenylalanine plus a continuous infusion of 0.01 M tryptophan shifted the dose-response curve to the left and resulted in a significantly greater response than to either amino acid alone. In five subjects with parietal cell vagotomy, intravenous phenylalanine and tryptophan stimulated acid secretion, whereas histidine was without effect, similar to normal subjects. These studies indicate that intravenous infusion of small amounts of phenylalanine (0.025 M, 3.1 mmol/h) and tryptophan (0.01 M, 1.25 mmol/h) stimulated gastric acid secretion at plasma concentrations similar to those observed after a steak meal, suggesting a physiologic role for circulating levels of these amino acids on gastric acid secretion. Because acid secretion increased at a time when serum gastrin was unchanged and since there was no correlation between changes in serum gastrin and acid secretion, the responses to phenylalanine and tryptophan are probably mediated by a nongastrin-related mechanism(s). Since both phenylalanine and tryptophan stimulated secretion in vagotomized subjects, the response is vagally independent. These observations suggest that circulating levels of these two amino acids have either a direct or indirect effect on or near the human parietal cell.

Amino Acids↗
PubMed1998

Bolus intravenous infusion of amino acids or lipids does not stimulate gallbladder contraction in neonates on total parenteral nutrition.

BACKGROUND/PURPOSE: Stimulation of gallbladder contraction in patients receiving total parenteral nutrition (TPN) may be beneficial in preventing cholestatic jaundice associated with TPN. Bolus intravenous administration of either amino acids or fat promotes gallbladder contraction in normal adult volunteers after a period of starvation. This phenomenon has not been investigated in patients receiving continuous TPN. The aim of this study was to test the hypothesis that bolus intravenous infusion of amino acids or fat produces gallbladder contraction in neonates receiving TPN. METHODS: Twenty-eight studies of gallbladder contraction were performed in 18 neonates receiving continuous TPN (median weight, 2.3 kg; range, 1.3 to 7.3; gestational age, 37 weeks; range, 28 to 40; age, 6.5 days; range, 2 to 180). Different types of experiments were performed: (1) bolus intravenous infusion of amino acid or fat for 60 minutes at twice the normal infusion rate; (2) bolus intravenous infusion of amino acid or fat for 15 minutes at four times the normal infusion rate. Gallbladder volume was measured by real-time ultrasonography by a single investigator. Measurements were made before starting the bolus infusion and every 15 minutes for 1 hour. RESULTS: The volume of the gallbladder before bolus intravenous infusion was not significantly different between experiments (median, 985; range, 603 to 1,802 mm3). These volumes are consistent with an enlarged and atonic gallbladder as previously reported in infants receiving parenteral nutrition. In all experiments there was no significant decrease in gallbladder volume after bolus infusion of either amino acids or fat. CONCLUSIONS: Contrary to their effects in adults, bolus infusions of amino acids or fat did not induce gallbladder contraction in neonates on TPN. This may have been because of lack of starvation in the neonates and/or the effect of continuous glucose infusion.

Amino Acids↗
PubMed1997

Bacterial colonization and endotoxin contamination of intravenous infusion fluids.

Bacterial colonization and endotoxin contamination of intravenous infusion fluids and catheter systems were examined in a surgical intensive care unit. Nineteen consecutive patients were randomly assigned to 48 h (N = 8) or 96 h (N = 11) change of infusion systems. Fluid from infusion bottles (51), infusion bottles plus burettes (102) and catheter systems (104) was cultured quantitatively for aerobic and anaerobic bacteria. Swabs (362) were taken from three-way stopcocks before and after the in-line infusion filters. Total and free endotoxin levels in infusion fluids were measured by quantitative chromogenic Limulus assay. The overall rate of bacterial colonization of bottles/burettes was 7.8% at 48 h and 15.7% at 96 h, while colonization rates of catheter fluid were 34.0% and 24.1%, respectively (n.s.). These high rates of colonization, despite regularly reinforced hand disinfection practices, may be explained by the high frequency of manipulations of the catheter systems, during acute interventions in emergency situations. Cell-bound endotoxin was found in 8.8% of the samples, but only 2.5% of the samples contained free endotoxin. The data support the use of in-line infusion filters, with bacterial-retaining property; however, these filters need not have endotoxin-retaining properties.

Aged↗
PubMed1998

A method for rapid intravenous infusion in shock resuscitation.

A technique for rapid intravenous infusion is described for patients in extremis. Using readily available materials, the saphenous vein at groin level is cannulated with an oversized catheter. Excellent flow rates are achieved.

Catheterization, Central Venous↗
PubMed1990

[Histopathological studies on antitumor effect of tegafur administered by continuous intravenous infusion].

The effects of preoperative treatment by continuous intravenous infusion of Tegafur, the antagonist of DNA synthesis, were histopathologically studied in 34 patients with gastric cancer. Histologically the treatment was found to be effective in 41.2% of patients with cancer invasion in the mucosa, 58.8% in the submucosa, 61.3% in the muscularis propria, 59.3% in the subserosa and 86.9% of those with metastatic lymph nodes. The treatment was effective, when assessed in terms of the histological type of cancer, in 90.9% of cancers of the differentiated type (papillary adenocarcinoma, well differentiated tubular adenocarcinoma and moderately differentiated tubular adenocarcinoma) and 47.8% of those of the poorly differentiated type (poorly differentiated adenocarcinoma, mucinous adenocarcinoma and signet-ring cell carcinoma), showing a higher rate of efficacy in the differentiated type cancers. Meanwhile, even among patients with cancer of poorly differentiated type, a high efficacy rate (90.0%) was found in those with metastatic cancer of the lymph nodes. No relationship was found between the total doses of Tegafur and histological effects. There was a tendency, however, for a higher frequency of a good response in patients administered more than 4,000 mg of Tegafur. In the patients with a histologically positive effect, 5-FU concentration in the tumor tissue was higher than 0.071 microgram/g. However, some patients showed no response despite a high concentration. This finding suggested that sensitivity to 5-FU and 5-FU metabolism vary depending on the tumor. The inhibitory effect of Tegafur on DNA synthesis is produced through inhibition of thymidylate synthase (TS) by the Tegafur metabolite FdUMP.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗