運用實證手法建置非化療高外滲風險藥品清單

Development of Evidence-Based Approach on Non-Cytotoxic Vesicants List

王詩瑋(Shih-Wei Wang) ； 吳承誌(Cheng-Chih Wu) ； 戴慶玲(Ching-Ling Tai) ； 王郁青(Yu-Chin Lily Wang)

《臺灣臨床藥學雜誌》 29卷3期 (2021/07) Pp. 161-173

https://doi.org/10.6168/FJCP.202107_29(3).0006

摘要

目的：周邊靜脈注射導致外滲事件發生的可能原因與藥品特性、病人特徵及操作過程有關，酸鹼值、滲透壓和藥物特性是非化療藥物造成組織傷害的機轉。鑒於各醫院對於化療藥物的外滲風險程度及處置都有明確的定義及作法，而對於非化療藥品導致外滲的警覺則相對不足，因此，本研究旨在制定出本院非化療外滲藥品清單供臨床醫護人員參考。方法：本研究利用Cochrane、PubMed及Embase進行文獻搜尋，納入證據力較高的系統性綜論及包含外滲藥品清單的敘述性綜論。藉由詳細的方法學評讀挑選出最佳證據作為整合依據，兩個清單以上提及的藥品即納入第一版外滲藥物清單，供護理單位進行外滲經驗調查。透過整合臨床經驗及最佳證據擬定本院非化療高外滲風險藥品清單。結果：初步納入四篇文獻回顧，分別提出53、28、29、20種本院現存且具高外滲風險的藥品，限縮曾於兩篇以上文獻回顧提出的藥品為36種，經護理單位進行經驗調查後，共回報25種藥品曾發生過外滲事件，由23種列於清單內之藥品及其他2種未列於清單的藥品組成，經重複比對及排除後整合出27種藥品形成本院清單。結論：此非化療高外滲風險藥品清單的建立，可提高護理人員於臨床施打時的警覺，降低外滲事件的發生機率，亦可作為後續系統提示建構的依據。

關鍵字

外滲 ； 非細胞毒性 ； 實證

並列摘要

Objective: Extravasation during peripheral intravenous injection is related to physical or biologic factors of medications, patient morbidity, and the procedure of injection. The mechanism of tissue damage from non-cytotoxic agents includes extreme pH, osmolality, and pharmacological property. Explicit definition on risk stratification of cytotoxic agents and standard operating procedure of extravasation treatment were promulgated; however, limited alert has been constructed on awareness on extravasation of non-cytotoxic vesicants. This study aims to establish the list of non-cytotoxic vesicants as reference for health professionals. Methods: Systematic reviews and narrative reviews with non-cytotoxic vesicants list have been searched in Cochrane, PubMed, and Embase. The agents which presented in two or more included studies were enrolled in the prototype list. The prototype list would be used to investigate the experience of extravasation in different wards. The final non-cytotoxic vesicants list would be established based on the best evidence and clinical experience. Results: Four review articles were included with 53, 28, 29, and 20 non-cytotoxic vesicants, respectively. Thirty-six medications have been mentioned in two or more included studies. After the surveillance, 25 agents were reported with extravasation, which included 23 agents in the prototype list. The final list is composed of 27 non-cytotoxic vesicants. Conclusion: The development of non-cytotoxic vesicants list could enhance the awareness for nurses during the process of peripheral intravenous injection to reduce incidence of extravasation or phlebitis. Moreover, the list could also be integrated into the alert system for the comprehensive evaluation of patient before and after the procedure of injection.

並列關鍵字

Extravasation ； Non-Cytotoxic Agent ； Evidence-Based