Case 1: The input amount is not controlled correctly
One day at noon, colleague A looked panicked and asked me: "What to do?" 02 bed originally as long as the infusion of 125ml of sodium bicarbonate, I also marked the line, and told the patient to pay more attention, just too busy, did not have time to patrol, a whole bottle (250ml) are finished. "
In the clinic, the specification of sodium bicarbonate is 250ml a bottle, while the doctor's order is generally 125mlqd or q8h, and the speed requirement is slightly faster than the conventional speed.
In practice, nurses generally draw a line across the bottle to estimate the amount. There are often many problems with such an approach:
(1) The inspection is not timely, and the phenomenon of a whole bottle being empty appears;
(2) Because sodium bicarbonate is a plastic bottle, during the infusion process, due to internal and external pressure, the bottle body will be empty, even if the line has been drawn before, it is impossible to accurately judge the amount of input;
(3) The evaluation of subjective experience is not accurate.
The instructions for sodium bicarbonate indicate that excessive input has the following adverse reactions:
(1) When a large number of injections, arrhythmias, muscle spasms, pain, abnormal tiredness and weakness can occur, mainly due to hypokalemia caused by metabolic alkalosis.
(2) When the dose is too large or there is renal insufficiency, edema, psychiatric symptoms, muscle pain or convulsions, slowing of breathing, odor in the mouth, abnormal tiredness and weakness may occur. Mainly caused by metabolic alkalosis.
(3) Long-term application can cause urinary frequency, urgency, persistent headache, loss of appetite, nausea and vomiting, abnormal tiredness and weakness.
How to control the amount of sodium bicarbonate relatively precisely?
(1) Proficiency in the dosage and adverse reactions of sodium bicarbonate and precautions.
In the calculation formula of acid-base and electrolyte supplementation, the author found that the calculation formula for the amount of 5% sodium bicarbonate is: 5% sodium bicarbonate (ml) = [(normal co2cp- measured co2cp) (mmol/l)] x 0.42x w (kg).
Where, co2cp represents the carbon dioxide binding force, which is normally calculated at 22mmol/l, and w represents body weight.
(2) It can be discarded by extracting 125 ml with a sterile syringe before infusion, which is time-consuming, increases the workload, and increases the risk of infection.
(3) The infusion pump is used for infusion, which can improve the efficiency and flexibility of clinical drug delivery operations and reduce the workload of nursing.
However, what needs to be vigilant is that if the drug extravasation occurs during the infusion process, the infusion pump has no exudative alarm system, if positive and correct measures are not taken in time, serious consequences will occur, and it is easier to mislead nurses to mistakenly think that the infusion pipeline is safe and reliable, ignoring the leakage problem, affecting the treatment effect or causing skin necrosis.
(4) If the input is excessive, pay close attention to the patient's symptoms, track the results of electrolyte, blood gas analysis and other examinations, and make corresponding treatment in time.
(5) Do a good job of health education to dispel patients' worries.
Case 2: The timing of the infusion is controversial
During a shift shift, the successor nurse b found that the sodium bicarbonate in bed 09 had not been infused to the patient when checking the infusion card, the patient was a lymphoma patient, and cyclophosphamide (CTX) chemotherapy was given on the same day, b thought that sodium bicarbonate should be used before ctx chemotherapy, and the shift nurse C thought it should be used after ctx.
Sodium bicarbonate is an alkaline drug, which dissolves into na+ and hco3- immediately after entering the human body, which is constantly combined with h+ to become hydrogen carbonate, so that the concentration of h+ in body fluids is reduced, the pH value of the blood is improved, and the excretion of bicarbonate in the urine is increased while alkalizing the urine, thereby preventing the occurrence of uric acid kidney disease.
Clinically, cyclophosphamide chemotherapy is administered, and the usual practice is to first infuse 5% sodium bicarbonate in order to maintain an alkaline environment when transfusing ctx and reduce the nephrotoxicity of ctx (hemorrhagic cystitis).
According to the literature, CTX has the highest concentration in the urine 2-4 hours after medication, and 25%-30% of CTX active within 24 hours after medication is excreted from the urine.
Does sodium bicarbonate and ctx input sequence have an effect on reducing the toxicity of ctx? I believe that clinical nurses have the same confusion.
Effect of the order of administration on ctx toxicity
Some researchers have made a practical discussion on this, and 72 patients with multiple myeloma who use the chop regimen combined with chemotherapy are divided into 2 groups, one group uses sodium bicarbonate before ctx infusion, and the other group uses sodium bicarbonate after ctx infusion, which establishes observation indicators, and after using a relatively reasonable method, the results show that the infusion of sodium bicarbonate after ctx is better to reduce the nephrotoxity caused by ctx.
The reason is: infusion of sodium bicarbonate before ctx, sodium bicarbonate will be rapidly dissociated in a short period of time, ctx in the urine concentration of the highest time period, sodium bicarbonate has been completely dissociated and excreted, sodium bicarbonate action time can not be synchronized with the concentration of ctx in the urine to achieve synchronization, and after ctx infusion of sodium bicarbonate basically ensures the relative synchronization of the 2 drugs in the time of action.
Case three: Compatibility is contraindicated
When a new nurse D gave the patient sodium bicarbonate infusion, because the patient vomited severely, the doctor prescribed ondansetron hydrochloride injection to push it statically. d Select the pot in, that is, pull out the infusion needle, place the ondansetron injection ampoule, and immediately, the milky white cloudiness appears inside the Murphy dropper.
During intravenous infusion treatment, nurses should strictly follow the doctor's instructions, including dosage, injection route, etc.
Sodium bicarbonate is widely used in clinical practice, but there are contraindications to compatibility with many drugs:
(1) White turbidity will occur during sequential infusion with vinpocetine injection;
(2) Milky white turbidity will appear when injected sequentially with nicardipine hydrochloride for injection;
(3) White turbidity will appear when intravenously infused with Liyuexi (midazolam injection);
(4) White turbidity will appear when sequentially infused with pantoprazole sodium for injection;
(5) Milky white flocculent opacification occurs during sequential infusion with quinolones (ciprofloxacin);
(6) Sequential infusion with Shu hening injection will change from light yellow to grass green;
(7) Milky white turbidity occurs when sequentially infused with amiodarone hydrochloride injection;
What other problems do you encounter during the use of sodium bicarbonate? How to solve it? What better advice do you have for precisely controlling usage? Welcome to share in the message area~
bibliography:
Liu Weizhen,Yuan Shuping,Wang Shuwei. There are contraindications to the compatibility of sodium bicarbonate injection with a variety of drugs[j].Chinese Journal of Practical Nursing,2013,29(2):63.
Yan Guihuan,Hong Yingbin. Observation on the effect of static sodium bicarbonate on reducing cyclophosphamide nephrotoxicity[j].Chinese Journal of Practical Nursing,2005,21(4):3-4.
Author / Wu Zefang Source / Chinese Nursing Management
![Chemistry: Sodium bicarbonate (baking soda)[fig]](data:image/gif;base64,R0lGODlhAQABAIAAAP///wAAACwAAAAAAQABAAACAkQBADs=)