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Epinephrine syringe exchange events in a paediatric cardiovascular ICU: analysing the storm

Published online by Cambridge University Press:  04 December 2017

Barbara-Jo Achuff Open the ORCID record for Barbara-Jo Achuff [Opens in a new window] ,
Jameson C. Achuff ,
Hwan H. Park ,
Brady Moffett ,
Sebastian Acosta ,
Craig G. Rusin  and
Paul A. Checchia
Barbara-Jo Achuff*
Affiliation:
Cardiac Critical Care, Texas Children’s Hospital, Houston, Texas, United States of America
Jameson C. Achuff
Affiliation:
Applied Mathematics, Carnegie Melon University, Pittsburgh, Pennsylvania, United States of America
Hwan H. Park
Affiliation:
Applied Mathematics, Rice University, Houston, TX, United States of America
Brady Moffett
Affiliation:
Clinical Pharmacy, Texas Children’s Hospital, Houston, TX, United States of America
Sebastian Acosta
Affiliation:
Section of Cardiology, Baylor College of Medicine, Houston, Texas, United States of America
Craig G. Rusin
Affiliation:
Section of Cardiology, Baylor College of Medicine, Houston, Texas, United States of America
Paul A. Checchia
Affiliation:
Cardiac Critical Care, Texas Children’s Hospital, Houston, Texas, United States of America
*
Correspondence to: B.-J. Achuff, MD, FAAP, Cardiac Critical Care, Texas Children’s Hospital, 6621 Fannin Street Suite 6006, Houston, TX 77030, United States of America. Tel: +832 826 0614; Fax: +832 825 7422; E-mail: bxachuff@texaschildrens.org
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Abstract

Introduction

Haemodynamically unstable patients can experience potentially hazardous changes in vital signs related to the exchange of depleted syringes of epinephrine to full syringes. The purpose was to determine the measured effects of epinephrine syringe exchanges on the magnitude, duration, and frequency of haemodynamic disturbances in the hour after an exchange event (study) relative to the hours before (control).

Materials and methods

Beat-to-beat vital signs recorded every 2 seconds from bedside monitors for patients admitted to the paediatric cardiovascular ICU of Texas Children’s Hospital were collected between 1 January, 2013 and 30 June, 2015. Epinephrine syringe exchanges without dose/flow change were obtained from electronic records. Time, magnitude, and duration of changes in systolic blood pressure and heart rate were characterised using Matlab. Significant haemodynamic events were identified and compared with control data.

Results

In all, 1042 syringe exchange events were found and 850 (81.6%) had uncorrupted data for analysis. A total of 744 (87.5%) exchanges had at least 1 associated haemodynamic perturbation including 2958 systolic blood pressure and 1747 heart-rate changes. Heart-rate perturbations occurred 37% before exchange and 63% after exchange, and 37% of systolic blood pressure perturbations happened before syringe exchange, whereas 63% occurred after syringe exchange with significant differences found in systolic blood pressure frequency (p<0.001), duration (p<0.001), and amplitude (p<0.001) compared with control data.

Conclusions

This novel data collection and signal processing analysis showed a significant increase in frequency, duration, and magnitude of systolic blood pressure perturbations surrounding epinephrine syringe exchange events.

Keywords

cardiac critical carevasoactive medicationsyringe pumpdrug deliveryquality
Type
Original Articles
Information
Cardiology in the Young , Volume 28 , Issue 3 , March 2018 , pp. 409 - 415
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Copyright
© Cambridge University Press 2017 

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