American journal of hospital pharmacy
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The development of a home i.v. antimicrobial therapy program and associated procedures for patient teaching are described. The pharmacy department at a 940-bed, acute-care, general medical-surgical teaching hospital participated with four other departments in the development of standardized teaching methods for a home i.v. antimicrobial therapy program. The pharmacy and nursing departments each developed sections of a home antimicrobial therapy manual. ⋯ Most patients or their care-givers were able to prepare and administer the medications. After the patient was discharged, the pharmacy department offered services such as supplying medications, coordinating pharmacokinetic dosing, providing drug information, and acting as a patient contact. Hospitals that provide home i.v. antimicrobial therapy should coordinate the resources of the various departments involved to develop standardized patient-teaching methods.
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Factors affecting solubilities of calcium and phosphate in neonatal total parenteral nutrient (TPN) solutions containing a new amino acid formulation were examined. Twelve TPN solutions containing various concentrations of TrophAmine, an amino acid formulation specific for infants and young children, were prepared in 10% dextrose injection. Some of the solutions also contained cysteine hydrochloride 40 mg/g of protein and either sodium bicarbonate or hydrochloric acid (lipid emulsion buffer) to buffer the solution pH to simulate that produced by simultaneously administering lipid emulsion through the i.v. line. ⋯ Solubility curves were prepared by plotting graphically the concentrations at which either visual or microscopic precipitation occurred. Temperature, amino acid concentration, and the addition of cysteine hydrochloride and lipid emulsion buffer each influenced the solubilities of calcium and phosphate in the TPN solutions. The use of TrophAmine as the amino acid source allowed slightly greater concentrations of phosphate to be solubilized as compared with older amino acid formulations.(ABSTRACT TRUNCATED AT 250 WORDS)
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The sterility of trypticase soy broth (TSB) that was frozen and thawed in disposable plastic syringes and infused via syringe pump was studied to determine whether ambient air or personnel-transferred contaminants compromised the sterility of the solution. Samples of TSB (10, 20, 30 mL) were prepared aseptically in syringes of three different brands--150 samples for each volume (50 for each manufacturer). The syringes were placed in zip-lock bags, stored for 24 hours at -15 to -20 degrees C, and thawed for three hours. ⋯ There was no growth in any of the test infusion samples or in samples that were intentionally contaminated. The negative controls showed no growth; all of the positive controls showed growth. The sterility of solutions frozen in disposable plastic syringes does not appear to be compromised by touch contamination of the plunger shaft or by airborne microorganisms settling on the infusion system.
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In vitro testing of drug delivery via dual-lumen, small-volume i.v. extension tubing designed for use with a syringe pump was conducted. From a dual-lumen extension set with intraluminal diameters of 0.020 inch, effluent samples were collected at 5, 10, and 20 minutes after injection of a 1-mL volume of drug solution intended for delivery over 20 minutes by a syringe infusion pump. Variables were flow rate (5 or 25 mL/hr) of the primary infusion, tubing position (vertical or horizontal), and density of the drug solution (penicillin G potassium 250,000 units/mL and aminophylline 25 mg/mL represented high and low specific gravities, respectively). ⋯ A primary infusion flow rate of 5 mL/hr and flush volumes of 0.3 and 0.6 mL were used in this study. To determine the influence of intraluminal diameter on the flush volume required for delivery of a dose of aminophylline (1-mL volume), single-lumen extension tubings with different diameters were tested. The final percentage of the drug dose delivered via the dual-lumen extension set with 0.020-inch lumens was affected only by flush volume.(ABSTRACT TRUNCATED AT 250 WORDS)
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This article reviews normal acid-base regulation, related laboratory tests, and the potential disorders if the body's ability to compensate is disrupted. Acid derived from the oxidation of proteins and through tissue metabolism must be excreted or neutralized daily by the kidneys and lungs to maintain a proper acid-base balance. Acid-base homeostasis is normally maintained by chemical buffering, changes in renal hydrogen-ion excretion, and alterations in the rate and volume of alveolar ventilation. ⋯ The increased Pco2 in this conditions must be lowered slowly to avoid precipitating cardiac arrhythmias and seizures. The correction of respiratory alkalosis requires elevating the Pco2 and again treating the underlying disease. Pharmacists should be knowledgeable about acid-base regulation and the disorders that frequently occur with disease because drugs are capable of inducing or exacerbating these disorders and are often key elements in therapy.