{
  "abstract": "Background and Importance Syringe replacement during norepinephrine administration is a critical process and may cause hemodynamic instability. Since our hospital switched from aseptically prepared ready-to-administer syringes (A-RTA-S) to sterilised ready-to-administer syringes (S-RTA-S), safety incidents of systolic blood pressure elevations were reported.Aim and Objectives The aim of this study was to assess the frequency, cause, and magnitude of these changes in systolic blood pressure after using S-RTA-S.Material and Methods First, a retrospective clinical study was conducted to quantify the number of patients with clinically relevant blood pressure elevations following syringe replacements with A-RTA-S and S-RTA-S. Then, laboratory flow rate measurements were performed while simulating syringe replacements. Finally, a laboratory root cause analysis was conducted to determine the effects of variations in various parameters that affect peak flow rate. Peak flow rate directly after the syringe pump picked up the plunger was defined as bolus 1; peak flow rate minus set flow rate directly after start of infusion was defined as bolus 2.Results In the study period a total number of 59 patients received norepinephrine at ICU of which 35 patients with S-RTA-S and 24 patients with A-RTA-S. The mean elevation of systolic blood pressure after syringe replacement was 22.9 mmHG in the S-RTA-S group and 3.9 mmHG in the A-RTA-S group. Clinically relevant blood pressure elevations of ≥ 30 mmHG occurred in 10/35 (28.6%) patients in the S-RTA-S group and in none (0%) of the patients in the A-RTA-S group (n=24;p=0.004). These blood pressure elevations were observed after 15 (29.4%) of S-RTA-S replacements (n=51) versus 0 (0%) of A-RTA-S replacements (n=31;p=0.001). Peak flow rate bolus 1 was significantly higher in S-RTA-S than in A-RTA-S (13.7±5.5 ml/hour versus 1.8±1.3 ml/hour;p=0.003). For bolus 2, peak flow rates were 23.5±3.5 ml/hour versus 2.0±3.4 ml/hour, respectively (p<0.001). Peak flow rate was impacted most by height of the pump in relation to simulated bed height.Conclusion and Relevance Significant temporary increases in blood pressure occurred in 29% of patients after syringe replacement with norepinephrine using sterilised syringes. These increases were caused by the observed boluses with S-RTA-S. The first bolus following syringe replacement can be neutralised by placing the syringe pump equal to bed height.Conflict of Interest No conflict of interest",
  "authors": [
    {
      "affiliations": [
        "Catharina Hospital Eindhoven, Hospital Pharmacy, Eindhoven, The Netherlands"
      ],
      "name": "T Manten"
    },
    {
      "affiliations": [
        "Catharina Hospital Eindhoven, Hospital Pharmacy, Eindhoven, The Netherlands"
      ],
      "name": "S Wessels-Basten"
    },
    {
      "affiliations": [
        "Catharina Hospital Eindhoven, Hospital Pharmacy, Eindhoven, The Netherlands"
      ],
      "name": "M van Hauwe"
    },
    {
      "affiliations": [
        "Catharina Hospital Eindhoven, Hospital Pharmacy, Eindhoven, The Netherlands"
      ],
      "name": "T Koning"
    },
    {
      "affiliations": [
        "Isala Hospital, Hospital Pharmacy, Zwolle, The Netherlands"
      ],
      "name": "K Larmené-Beld"
    },
    {
      "affiliations": [
        "Catharina Hospital Eindhoven, Hospital Pharmacy, Eindhoven, The Netherlands"
      ],
      "name": "C Peeters"
    },
    {
      "affiliations": [
        "Catharina Hospital Eindhoven, Hospital Pharmacy, Eindhoven, The Netherlands"
      ],
      "name": "R van Wezel"
    },
    {
      "affiliations": [
        "Catharina Hospital Eindhoven, Hospital Pharmacy, Eindhoven, The Netherlands"
      ],
      "name": "M Deenen"
    }
  ],
  "title": "5PSQ-118 Temporary systolic blood pressure elevations following norepinephrine syringe replacements with sterilised ready-to-administer syringes in critically ill patients",
  "uid": "6f284ba3-76a3-5425-aafb-06ccf2379efc"
}