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PubMedDate not supplied

Effects of low-dose heparin on failure of intravenous infusions in children.

OBJECTIVE: To determine if a dextrose-saline solution manufactured under commercial conditions and containing 1 IU per ml of heparin prolongs the use of infusion sites in children. DESIGN: Double-blind randomized trial. PATIENTS: Eighty children in a medical ward. OUTCOME MEASURES: Failure of infusion sites from phlebitis and/or extravasation. INTERVENTION: Duration of use of infusion sites was calculated to the nearest hour. STATISTICS: Univariate survival analysis. RESULTS: The median time to failure when solutions contained the heparin (97 hours) was significantly increased (p < 0.0001) compared with control solutions (43 hours). CONCLUSIONS: Use of solutions containing low-dose heparin is recommended for children who might have problems with venous access.

Catheters, Indwelling↗
PubMed1991

Phenytoin administration by constant intravenous infusion: selective rates of administration.

STUDY OBJECTIVES: To determine the adequacy of seizure control and the adverse effects of administering an IV loading dose of phenytoin by constant infusion pump. DESIGN: A prospective study of patients presenting with acute onset of seizures. Patients were divided into two groups. Group 1 comprised all patients 50 years of age or younger without a history of atherosclerotic cardiovascular disease (ASCVD). Group 2 comprised all patients older than 50 years or with a history of ASCVD. SETTING: A rural community hospital emergency department. TYPE OF PARTICIPANTS: Forty-two adult patients. INTERVENTIONS: Both groups received an IV loading dose of phenytoin at 15 mg/kg. Infusion rates were 50 mg/min and 25 mg/min for groups 1 and 2, respectively. Cardiac rhythm and vital signs were monitored throughout and after infusion. MEASURES AND MAIN RESULTS: Group 2 demonstrated significantly more cardiovascular side effects (hypotension and bradycardia) than did group 1 (Fisher's exact test, P less than .05). CONCLUSION: Phenytoin provided adequate seizure control in both groups. For individuals with ASCVD, IV phenytoin administration rates should not exceed 25 mg/min. For individuals without ASCVD, phenytoin administration at 50 mg/min appears safe and without significant cardiovascular side effects.

Adult↗
PubMed1990

Intravenous catheter aspiration for obtaining basic analytes during intravenous infusion.

The aspiration of blood through a functioning IV line to obtain samples for laboratory analysis was evaluated. Thirty-eight emergency department patients were studied. Each had an 18-gauge IV catheter placed and then received a 100-mL bolus of either normal saline, lactated Ringer's, or 5% dextrose in water. Two samples of blood ("first aspirate" and "second aspirate") were then aspirated from the IV catheter while one sample was obtained by venipuncture from the opposite arm (control). All three samples were then analyzed for CBC, electrolytes, BUN, creatinine, and glucose. Catheter aspiration succeeded in 30 of 38 attempts (79%). Three samples were hemolyzed, and five samples were unable to be fully aspirated. Results of paired t testing showed only occasional statistical significance and except for bicarbonate were not of clinical significance. This study suggests that catheter aspiration is a useful method of obtaining blood for certain laboratory tests in patients receiving IV infusions.

Blood Specimen Collection↗
PubMed1987

A comparative study of intraosseous versus peripheral intravenous infusion of diazepam and phenobarbital in dogs.

Authors of recent literature have made several references to the use of intraosseous infusion in emergency situations. This method has provided a useful route of medication and fluid administration when peripheral IV access has been unsuccessful. Controlled studies on intraosseous infusion have been limited. To more accurately evaluate the effectiveness of this technique, we administered diazepam to 20 dogs randomly assigned to either peripheral IV (n = 10) or tibial intraosseous (n = 10) groups. Intramedullary placement usually was performed within 15 seconds. Central venous diazepam samples were collected at one-, three-, six-, ten-, and 20-minute intervals. Intraosseous infusion achieved and maintained serum diazepam levels comparable to those achieved by IV administration. This study was repeated with phenobarbital using a different set of 20 dogs with samples collected at one-, three-, six-, and ten-minute intervals. Results were similar in that the levels were comparable regardless of the use of intraosseous or IV administration. Complications using this technique have been few. When peripheral IV access is unobtainable, intraosseous infusion has been shown to be an effective and efficient alternative for administering medications and fluids.

Animals↗
PubMed1994

Hydrodynamic evaluation of intravenous infusion systems.

STUDY OBJECTIVE: We investigated the hydrodynamic characteristics of IV infusion sets for rapid fluid resuscitation. A simple technique has been devised for quantitative evaluation of the hydrodynamic characteristics of IV sets, including their components, for a range of infusion pressures. SETTING AND METHODS: Previous investigations have measured the overall flow rate of infusion sets with and without IV catheters. This study presents a quantitative technique for measuring the resistance to flow of the IV delivery set as a whole as well as its components. An infusion set was measured with 14- and 18-gauge IV catheters while delivering fluid at infusion pressures between 50 (gravity) and 400 mm Hg. MEASUREMENTS AND MAIN RESULTS: At gravity-driven infusion, the drip chamber imposes a resistance to flow of the same order as that of the catheter. At pressurized infusion with small-bore catheters, the catheter consumes the majority of the overall pressure drop. At pressurized infusion with a large-bore catheter or tubing, the standard drip chamber becomes the limiting component and imposes the largest resistance to flow. CONCLUSION: At gravity-delivered pressures (50 and 100 mm Hg), the only effective way of increasing flow rate (more than twofold) is to use a low-resistance drip chamber or to use two infusion sites. At pressurized delivery pressures (more than 200 mm Hg), increasing catheter size from 18 to 14 gauge would be more effective than doubling the number of infusion sets. Also, a more efficient drip chamber adds an important advantage. Finally, increasing the tubing diameter adds only minimal benefit.

Catheterization, Peripheral↗
PubMed1997

Continuous intravenous infusion of naloxone does not change behavioral, cardiovascular, or inflammatory responses to subcutaneous formalin in the rat.

The opioid antagonist, naloxone, produces equivocal effects on the magnitude of nociceptive responses in several animal models of persistent pain, including the formalin test. Hindpaw injection of dilute formalin produces not only inflammation but also phasic (Phase 1) and persistent (Phase 2) behavioral and cardiovascular nociceptive responses in the rat. To test the hypothesis that endogenous opioid systems contribute to the magnitude of responses to intraplantar formalin injection, we evaluated the effects of continuous naloxone administration (0.01-100 mg/kg per h, i.v.) on formalin-evoked hindpaw inflammation, on behavioral indices of pain, flinching and licking pain behavior, and on changes in mean arterial pressure and heart rate. We report that naloxone, at doses less than 100 mg/kg per h, did not change any formalin-evoked response. Although the 100 mg/kg per h dose significantly decreased these responses, it also produced muscle rigidity and profound bradycardia. We conclude that endogenous opioids do not significantly modulate the nociceptive processing induced by subcutaneous formalin.

Animals↗