Analysis and Countermeasures of the calibration er

2022-08-26
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Analysis of the calibration error of sub packed infusion bags and Countermeasures

at present, sub packed infusion bags are widely used in clinical practice, such as pediatrics, cardiovascular department, chemotherapy department, need to strictly record the amount of in and out 10, open the oil return valve for patients, standardize the use of antibiotics and rescue medication for critically ill patients, and its advantages are self-evident. But in actual work, most nurses found that the scale on the infusion bag was inconsistent with the actual situation. Separating fluids according to this scale may cause adverse consequences such as insufficient intake, vascular stimulation and renal function damage. Now, three kinds of infusion bags are tested repeatedly in order to find some rules of deviation, and the correct scale is marked on the sub packed infusion bag for the reference of nurses, so as to reduce the error and ensure the infusion safety of patients

1 materials and methods

1 1. Materials

three kinds of sub packed infusion bags with specifications of 250 ml are selected, and the places of origin are Sichuan Kangda company, Sichuan polymer products Co., Ltd. and Shandong Weihai medical devices company respectively; 300 ml measuring cup, scissors, vascular forceps, 5% glucose or normal saline

1. 2 methods

take 10 infusion bags of 3 kinds, number them, and divide them into 3 groups, namely 1 group, 2 groups, and 3 groups. Then cut and discard the connecting tube at 1 cm at the lower end of the infusion bag, clamp the broken end with vascular forceps, connect the infusion bottle, put 50 ml, 100 ml, 150 ml, 200 ml, 250 ml liquid into the bag according to the scale in two states of opening and not opening the dosing hole, open the vascular forceps, put the liquid into the measuring cup, and measure its actual volume. Each scale of an infusion bag is measured 5 times. After measuring a set of data, replace a separator bag for a total of 10 times. Record the results and calculate the average value

2 results

the error between the liquid volume shown on each scale and the actual liquid volume of the sub packaged infusion bags provided by the three manufacturers in two states is shown in Table 1. Table 1 shows: ① the less liquid contained in the infusion bag, the greater the error; ② If the dosing hole of the infusion bag is opened during liquid discharge, the error is relatively reduced; ③ The error of the same scale liquid volume of infusion bags from different manufacturers is different

3 discussion

3 1. The accuracy of infusion volume

affects the treatment and rescue results of patients. Infusion is an important clinical treatment method, and most drugs need to play a role through intravenous input [1]. Infusion sub bags are often used for inputting antibiotics, antineoplastic drugs, rescuing shock and critically ill patients, medication for children, etc., which is convenient for rational preparation of drugs, ensuring blood drug concentration, reducing toxic and side effects of drugs, strictly controlling the input amount, etc. If the input is too much, it is easy to cause pulmonary edema and heart failure, especially in the elderly, children or patients with heart disease [2]; If the input volume is insufficient, it may lead to high blood drug concentration, stimulate blood vessels or cause liver and kidney function damage [3, 4]. In serious cases, due to insufficient total intake, the circulating blood volume can be reduced, and the perfusion of important organs such as heart, brain and kidney is insufficient, resulting in severe consequences such as dyspnea, pulse speed, blood pressure drop, consciousness disorder, and even oliguria and anuria. Therefore, the accuracy of infusion volume is directly related to the treatment and rescue results of patients

3. 2. There is an error in dividing the liquid according to the scale marked on the infusion bag

the experimental results show that when the dosing hole is not opened, the average error of the 50 ml scale of the infusion bag is 27 ml, and the average error of 100 ml is 53ml, which is far from the actual liquid volume. Therefore, according to the scale of the infusion bag, the infusion volume is often less than the planned infusion volume, which is easy to cause the above-mentioned adverse consequences. For example, in March, 2000, a patient with advanced gastric cancer in our department was unable to eat due to illness. The doctor ordered 1600 ml per day (the patient had cardiac insufficiency when the tension was reduced by 5N). On March 18 and 19, he had oliguria for two consecutive days, 470 ml and 380 ml respectively. He was suspected of renal function damage, but the indicators of renal function were basically normal, Both ends of the sample can be assembled with the clamp and connector. The doctor reminded "this patient uses a sub packed infusion bag, will the input volume be insufficient?" after verification, according to the infusion bag scale, the actual patient input less than 1000 ml per day. After replenishment, the urine volume of the patient increased to 800 ml. It can be seen that the dose error caused by infusion according to the liquid volume shown on the scale of the infusion bag has a serious impact on the diagnosis and treatment of the disease

3. 3 reasons for the deviation of the liquid volume of the infusion bag scale

because the shape of the infusion bag made of plastic film is not fixed, atmospheric pressure, gravity and other factors can directly affect its expansion. Therefore, the less liquid is divided, the greater the deviation; When the dosing hole of the infusion bag is opened, the liquid level in the bag will drop under the action of atmospheric pressure, and the deviation will be relatively reduced. Therefore, the manufacturer's proportional scale cannot accurately indicate the liquid volume [5]

3. 4 reasons for inconsistent deviation

due to the different texture and specifications of the products of various manufacturers, some manufacturers' infusion bags have a hard and thick texture, and some manufacturers' dispensing bags have a relatively soft and thin texture; Some infusion bags have a specification of 16 5 cm × 9.9 cm, some 15 5 cm × 9.2 cm, etc. Therefore, the liquid volume error of the same scale of infusion bags from different manufacturers is inconsistent

4 countermeasures

4 1 when using the sub packed infusion bag, re mark the scale

the reverse test method is to use a standard measuring cup to measure the accurate amount of commonly used liquid (such as 50 ml, 100 ml, 150 ml, 200 ml, 250 ml, etc.), inject the infusion bag from the dosing hole by times with a syringe, observe the corresponding engraved degree on the infusion bag, and record the data. For each group of liquids tested, replace one infusion bag, and use 10 in total, that is, test 10 times for each scale. Calculate the average value of each scale. Mark the accurate amount measured by the reverse test method on the corresponding scale of the infusion bag, publish or post it in the treatment room, and the nurse can divide the liquid correctly according to the data provided, and keep it in mind for a long time. Table 2 shows a set of data of sub packaged infusion bags produced by Sichuan polymer products Co., Ltd. which are being put into clinical use after testing. If you need 100 ml of liquid, you need to put it into the infusion bag with a scale of 140 ml. Since April, 2001 to March, 2002, our department has adopted this method for sub loading and transportation, so it is necessary to ensure a constant feeding volume of 2860 times, including more than 1200 antibiotics, about 300 chemotherapy drugs, 86 emergency drugs and others, etc. There was no case of adverse consequences caused by fluid volume deviation. This method is simple and easy for nurses to master

4. 2 precautions

when using the reverse test method, in order to ensure the accuracy of the amount of liquid injected into the infusion bag, the dosing hole should be fully opened to make the liquid level fall, so as to ensure the accuracy of the measured results; When using the infusion bag for liquid separation, the nurse should also open the dosing hole and put the correct scale of the required liquid volume on the infusion bag; When replacing the sub packed infusion bags of another manufacturer, it is necessary to retest

5 summary

through clinical research, it is found that the liquid volume shown on the scale of commonly used infusion sub bags is greater than the actual liquid volume, and the less the liquid is divided, the greater the deviation. Through the reverse test method, the accurate amount of liquid is marked on the corresponding scale position of the infusion bag for the reference of nurses, which improves the nursing quality and work efficiency, and has achieved good clinical results, which is worthy of clinical promotion

author/Chen Xiaolian, Zhou Hongyan, Wang Xia, cen Yao, Tang Shu

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