İlaçların Uygulama Prensipleri: Parenteral İlaç Uygulama Prensipleri
Özet
Parenteral ilaç uygulamalarında geçimsizlik, infüzyon hızı ve ilaç etkileşimleri kritik öneme sahiptir. Yoğun bakım ünitelerinde yapılan en sık hataların infüzyon hızıyla ilişkili olduğu; özellikle antimikrobiyaller, sedatifler, analjezikler, vazopressörler ve insülinin en fazla hata yapılan grupları oluşturduğu belirtilmektedir. Ciddi enfeksiyonu olan kritik hastalarda antibiyotiklerin farmakokinetik ve farmakodinamik özelliklerine göre doğru dozlanması ve uygun sürelerde infüze edilmesi tedavinin başarısını belirlemektedir. Zamana bağlı etki gösteren penisilinler, sefalosporinler ve karbapenemlerin uzun süreli veya sürekli infüzyonlarla uygulanması mortaliteyi düşürmektedir; ancak sıcaklık ve çözücü gibi stabiliteyi etkileyen faktörler nedeniyle karbapenemler için 3 saatlik uzatılmış infüzyonlar önerilmektedir. Glisemik kontrol için kritik hastalarda sürekli regüler insülin infüzyonu önerilirken, insülinin polivinil klorür (PVC) yüzeylere yüksek oranda adsorbe olması nedeniyle polypropylene (PP) torbalarla 24 saatlik infüzyon yapılması daha akılcı bir yaklaşım olarak öne çıkmaktadır. Yoğun bakım ünitelerinde morbiditeyi azaltmak amacıyla uygulanan mekanik ventilasyona uyumu artırmak için sedasyon, analjezi ve vazoaktif tedaviler de ağırlık bazlı dozlama ve uygun konsantrasyonlu infüzyon çözeltileri hazırlanarak dikkatle yönetilmelidir.
In parenteral drug administration, incompatibility, infusion rate, and drug interactions are of critical importance. It is reported that the most common errors in intensive care units are related to the infusion rate, with antimicrobials, sedatives, analgesics, vasopressors, and insulin being the most error-prone drug groups. In critically ill patients with severe infections, the correct dosing and appropriate infusion durations of antibiotics according to their pharmacokinetic and pharmacodynamic properties determine treatment success. Administering time-dependent penicillin, cephalosporins, and carbapenems via prolonged or continuous infusions reduces mortality; however, extended 3-hour infusions are recommended for carbapenems due to stability-influencing factors such as temperature and solvent. For glycemic control, continuous regular insulin infusion is recommended in critically ill patients, and since insulin highly adsorbs to polyvinyl chloride (PVC) surfaces, performing a 24-hour infusion using polypropylene (PP) bags emerges as a more rational approach. To reduce morbidity in intensive care units, sedation, analgesia, and vasoactive therapies administered to improve compliance with mechanical ventilation must also be carefully managed by implementing weight-based dosing and preparing appropriate infusion concentrations.
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