Compatibilidad física del bicarbonato sódico con fármacos de uso frecuente en la unidad de cuidados intensivos / Physical compatibility of sodium bicarbonate with other drugs often administered in the intensive care unit

Introducción Las alteraciones acidobásicas se asocian a muchas afecciones del paciente crítico. Estos trastornos metabólicos requieren pronta normalización mediante bicarbonato sódico. Esta solución electrolítica alcalinizante se administra en infusión continua o intermitente. Se ha descrito su incompatibilidad por su pH alcalino, que produce precipitación de carbonatos insolubles y origina gases de dióxido de carbono al mezclarlo en soluciones ácidas. Objetivo Determinar la compatibilidad física del bicarbonato sódico 1M administrado en Y con fármacos de uso común en UCI.Material y método Estudio experimental in vitro. Se mezcló el bicarbonato con 13 fármacos simulando la administración en Y. Se combinaron 5 ml de bicarbonato con 5 ml de cada fármaco, eligiéndose concentraciones máximas utilizadas en la práctica. Las muestras se examinaron visualmente para detectar cambios de color, turbidez, precipitación o formación de gas; medición del pH y análisis espectrofotométrico a 450 nm y 620 nm. Se evaluaron las muestras a 0, 15, 30, 60 y 120 min. Los criterios de compatibilidad fueron: ausencia de cambios visuales, cambio pH<0,5 y variabilidad de absorbancia < 0,01.ResultadosSe estudiaron los fármacos individualmente y en mezcla con el bicarbonato, y resultaron 27 muestras, con las que se realizaron 135 determinaciones. Las incompatibilidades no siempre producen cambios visuales. Conocer el pH de los fármacos no garantiza la compatibilidad de la mezcla. La nitroglicerina con pH 4 es compatible. El tiopental con pH 11 precipita. Las absorbancias elevadas se acompañan de cambios de color, turbidez y precipitación.Conclusiones El bicarbonato es físicamente compatible con esmolol, furosemida, heparina, insulina, morfina, nimodipino, nitroglicerina y urapidil e incompatible con amiodarona, cisatracurio, haloperidol, midazolam y tiopental (AU)

Introduction Acid-base disorders are associated with many diseases of the critically ill patient. Early treatment with sodium bicarbonate of these metabolic disorders is required for their normalization. This is an alkaline electrolyte solution administered by continuous or intermittent infusion. Its incompatibility due to its alkaline pH has been described, as it produces insoluble carbonate precipitation and causes carbon dioxide gas when mixed with acidic solutions. Material and method An in vitro experimental study was performed. Bicarbonate was mixed with 13 drugs simulating Y-site administration. We combined 5ml bicarbonate with 5ml of every drug, at highest daily concentration used. The samples were visually examined to detect color changes, cloudiness, precipitation or gas formation, pH measurement and spectrophotometric analysis at 450nm and 620nm. The samples were evaluated at 0, 15, 30, 60 and 120minutes. The compatibility criteria were absence of visual changes, pH changes<0.5 and variability of absorbance <0.01.ResultsWe studied each drug individually and mixed with bicarbonate with 27 samples, and 135 measurements were performed. The incompatibilities did not always produce visual changes. Knowing the pH of drugs does not guarantee the compatibility of the mixture. Nitroglycerin with pH 4 is compatible with bicarbonate. Thiopental with pH 11 makes precipitation. Higher absorbances showed color changes, cloudiness and precipitation. Conclusions Bicarbonate is physically compatible with esmolol, furosemide, heparin, insulin, morphine, nimodipine, nitroglycerin and urapidil and incompatible with amiodarone, cisatracurium, haloperidol, midazolam and thiopental (AU)

[Physical compatibility of sodium bicarbonate with other drugs often administered in the intensive care unit]. / Compatibilidad física del bicarbonato sódico con fármacos de uso frecuente en la unidad de cuidados intensivos.

INTRODUCTION: Acid-base disorders are associated with many diseases of the critically ill patient. Early treatment with sodium bicarbonate of these metabolic disorders is required for their normalization. This is an alkaline electrolyte solution administered by continuous or intermittent infusion. Its incompatibility due to its alkaline pH has been described, as it produces insoluble carbonate precipitation and causes carbon dioxide gas when mixed with acidic solutions. MATERIAL AND METHOD: An in vitro experimental study was performed. Bicarbonate was mixed with 13 drugs simulating Y-site administration. We combined 5 ml bicarbonate with 5 ml of every drug, at highest daily concentration used. The samples were visually examined to detect color changes, cloudiness, precipitation or gas formation, pH measurement and spectrophotometric analysis at 450 nm and 620 nm. The samples were evaluated at 0, 15, 30, 60 and 120 minutes. The compatibility criteria were absence of visual changes, pH changes<0.5 and variability of absorbance <0.01. RESULTS: We studied each drug individually and mixed with bicarbonate with 27 samples, and 135 measurements were performed. The incompatibilities did not always produce visual changes. Knowing the pH of drugs does not guarantee the compatibility of the mixture. Nitroglycerin with pH 4 is compatible with bicarbonate. Thiopental with pH 11 makes precipitation. Higher absorbances showed color changes, cloudiness and precipitation. CONCLUSIONS: Bicarbonate is physically compatible with esmolol, furosemide, heparin, insulin, morphine, nimodipine, nitroglycerin and urapidil and incompatible with amiodarone, cisatracurium, haloperidol, midazolam and thiopental.

[Perception of privacy in patients hospitalized in an Intensive Care Unit]. / Percepción de la intimidad en pacientes hospitalizados en una Unidad de Cuidados Intensivos.

INTRODUCTION: The Intensive Care Unit (ICU) is an impersonal and technologically invasive setting. The rules and framework of the unit favor a lack of privacy, an inherent fact for every kind of hospitalization. The objectives of the study are to know the experience of patients admitted to the ICU in relation to the perception of privacy and its impact on their own experience. MATERIAL AND METHODS: Phenomenological qualitative methodology. The participants were patients admitted to the ICU of Son Dureta University Hospital in Palma de Mallorca, who were older than 18 with a minimum stay of 48 hours and who had signed an informed consent. Data collection. By exhaustive semi-structured interviews. Content analysis. RESULTS: The perception of privacy in patients admitted to the ICU is described in relationship with surrounding physical space, family setting and privacy autonomy. The patients evaluated the flexibility of rules, professionalism of the nursing staff and the need for family support when the situation is more stable. CONCLUSION: To prevent the quality of nursing cares from only depending on their technological knowledge and ability, but also depends on the humane side of caring, it is extremely important to consider the different elements that mould the experience of being admitted to the ICU and respect of the privacy of each person.

Percepción de la intimidad en pacientes hospitalizados en una Unidad de Cuidados Intensivos / Perception of privacy in patients hospitalized in an Intensive Care Unit

Introducción. La Unidad de Cuidados Intensivos(UCI) es un entorno impersonal y tecnológicamenteinvasivo. La normativa de la unidad y la estructuraarquitectónica favorecen la pérdida de intimidad,hecho que resulta inherente a toda hospitalización.Los objetivos del estudio son conocer la experienciade los pacientes ingresados en UCI en relación a lapercepción de intimidad y el impacto de esta sobresu experiencia.Material y métodos. Metodología cualitativafenomenológica. Los participantes fueron lospacientes ingresados en la UCI del HospitalUniversitario Son Dureta de Palma de Mallorca,mayores de 18 años, con una estancia mínima de 48horas tras consentimiento informado. Recogida dedatos: entrevistas semiestructuradas en profundidad.Análisis de contenido.Resultados. Se describe que la percepción de laintimidad en los pacientes ingresados en UCI serelaciona con el espacio físico que les rodea, elentorno familiar y la privacidad de autonomía. Lospacientes valoran la flexibilidad de las normas, laprofesionalidad del personal de enfermería y lanecesidad de apoyo familiar cuando la situación esmás estable.Conclusión. Con el fin de que la calidad de loscuidados enfermeros de las UCI no dependaúnicamente de los conocimientos y habilidadestecnológicos, sino que se caracterice por lahumanización de los mismos, es de suma importanciala consideración de los diferentes elementos quemodulan la experiencia de estar ingresado en unaUCI y el respeto a la intimidad de la persona

Introduction. The Intensive Care Unit (ICU) is animpersonal and technologically invasive setting.The rules and framework of the unit favor a lack ofprivacy, an inherent fact for every kind ofhospitalization. The objectives of the study are to know the experience of patients admitted to theICU in relation to the perception of privacy and itsimpact on their own experience.Material and methods. Phenomenologicalqualitative methodology. The participants werepatients admitted to the ICU of Son DuretaUniversity Hospital in Palma de Mallorca, whowere older than 18 with a minimum stay of 48hours and who had signed an informed consent.Data collection. By exhaustive semi-structuredinterviews. Content analysis.Results. The perception of privacy in patientsadmitted to the ICU is described in relationshipwith surrounding physical space, family setting andprivacy autonomy. The patients evaluated theflexibility of rules, professionalism of the nursingstaff and the need for family support when thesituation is more stable.Conclusion. To prevent the quality of nursing caresfrom only depending on their technologicalknowledge and ability, but also depends on thehumane side of caring, it is extremely important toconsider the different elements that mould theexperience of being admitted to the ICU and respectof the privacy of each person