Drug Information Response Assignment
Order ID |
53563633773 |
Type |
Essay |
Writer Level |
Masters |
Style |
APA |
Sources/References |
4 |
Perfect Number of Pages to Order |
5-10 Pages |
Description/Paper Instructions
Drug Information Response Assignment
Drug, Information, Response, Assignment
PS: The 4 sources are already selected by me. They are attached with my rough draft. There are 3 articles and a website (Lexicomp).
Page limit is 3 pages, including references***
Here is the rubric used for grading:
For citation (AMA style):
Here is my PICO: Use this in the literature summary (25% of the grade)
Step |
Item |
Response |
Step 1: |
Original Question |
Can 3% sodium chloride (3% hypertonic saline) be safely administered through a peripheral IV line? |
Step 2: |
Population |
Patient with elevated intracranial pressure. Patient with severe hyponatremia. |
|
Intervention/Exposure |
A typical initial rate of infusion of 3% sodium chloride is approximately 15 to 80
mL/hr. (1mL/kg/hour) for 2 to 3 hours. |
|
Comparator (if applicable) |
0.9%NS, 0.45% NS administration through peripheral IV Line, 5% dextrose in normal saline, Lactated Ringer’s solution. Central line administration for hypertonic saline. |
|
Outcome |
Adverse reactions of hypertonic saline through Peripheral line compared to Central line. |
Step 3: |
Well-developed clinical question |
What are the risks when hypertonic saline (3% saline) is administered through a peripheral IV Line? (Feel free to change to a better
Clinical question if you like) |
HERE IS MY DRAFT that I submitted for review
- Notice that I did not integrate my Pico in my Intro/background
Question:
Can 3% sodium chloride (3% hypertonic saline) be safely administered through a peripheral IV line?
Saline solutions are mixtures of Nacl and water. They are mainly classified into hypotonic 0.18-0.3%, isotonic or normal saline 0.9% and hypertonic saline 3% or more. Saline solutions are widely used in medicine from wound cleaning, rehydration to cosmetic. According to Lexicomp, 3% sodium chloride has an osmolality of 1025 mOsm/L which is higher than the 900 mOsm/L recommended for parenteral nutrition4. 3% Hypertonic saline is mostly used in clinical settings.
They are used in intracranial hypertension management and hyponatremia2. Traditionally, Hypertonic saline are administered via central line due to risk of damages to small veins if given via peripheral central line. However, it is common to see 3% sodium chloride used in clinical settings due to central line association with risk of complications such as infections, thrombosis, pneumothorax and delay of therapy for a patient in need of a time-sensitive therapy2,3. Therefore, is it safe for patients to get 3% sodium chloride through a peripheral IV line?
In a retrospective review study conducted on 66 patients who received 3% sodium chloride via Peripheral Venous Catheters (PVC) in Intensive care unit, Infusion-related adverse events (IRAEs) were collected from patients for analysis1. Complications such as Hyponatremia (29%) and cerebral edema (29%) were common.
6.1 % (4 of 66 patients) of patients experienced an IRAEs were aged between 38-82 years old and resulted with no permanent tissue damage1. 50% of patients who experienced IRAEs had their infusion restarted peripherally at another location1. Minimal damage was shown when the location was a large vein (80%) and 20–22-gauge catheters were used1. The onset time of IRAEs ranged from 2 to 94 hours (the median was 19 hours) after the start of the 3% Nacl infusion at a rate of 30 mL/h (median 32ml/h, IR 30-35).
Serum sodium at the beginning was 124 1.4 mEq/L compared to 131 1.3 mEq/L (P< .0001) at the end of the infusion which shows a rise in serum sodium1. Central line infusion is an invasive procedure that requires skills to perform but allows instant distribution and minimal vascular wall damages. PVC provides patients with acute symptomatic hyponatremia and elevated intracranial pressure rapid access and prompt distribution of the 3% Nacl1.This article shows that using PVC for hypertonic saline is not always dangerous. The risks of tissue damage and invasiveness of central line can be good arguments for the use of PVC.
In a retrospective cohort study that evaluated adult and pediatric patients who were given 3% NaCl or mannitol via Peripheral IV line in the emergency department to manage intracranial pressure elevations with a primary outcome of extravasation incidence (leakage around the site of injection)3. 192 patients were included in the study. 85 (44%) received 3% Nacl and 107 (56%) received mannitol with no extravasation in either group3.
In hospital mortality was higher in the mannitol group (54.7% vs. 32.9%; p = 0.003)3. In conclusion, since neither group experienced an extravasation, it is safe to use 3% sodium chloride peripherally in patients with elevated intracranial pressure at the ED.
In another article, a prospective study of patients admitted to Parkland Hospital Surgical ICU and who were treated with 3% NaCl via the peripheral IV catheter was collected from October 2013 to May 2014. 28 patients and 34 peripheral lines were monitored2. Infusion rates ranged from 30 to 50 ml/L for all subjects.
The duration of the infusion was 1 to 124 hours (mean 36 hours)2. 2 patients presented complications which included infiltration, with an incidence of 6%, and 1 patient with thrombophlebitis, with an incidence of 3% 2. The complications rate was 10.7% (n=3) among the patients and 11.7% (n=4) on assessed peripheral lines for 3 patients.
According to the article, thrombophlebitis is the most common complications of Peripheral IV line2. Duration of catheterization is an important indicator for thrombophlebitis with most patients at risk after 5 days of IV therapy2. The study concluded that 3% hypertonic saline peripheral administration presented low risk and non-life-threatening complications and that any concern and risk are therefore unfounded2.
In conclusion, according to current literature using hypertonic saline (3% NaCl) presents a low risk when administered via a peripheral IV line. Even though hypertonic saline is traditionally administered through a central line because of the osmolarity of 3% sodium chloride exceeds 900 mOsm/L and puts patient at risk of thrombophlebitis, tissue damage, and extravasation reactions, peripheral administration is preferred in emergencies and time sensitive therapies1,2,3,4.
Peripheral administration requires less skill and is less invasive than the central line. However, all the studies present limitations that could be reduced by conducting a randomized control trial or a prospective cohort study. Without a control group, it is hard to definitely say that 3% sodium chloride is safer when administered via a peripheral IV line versus central line.
I appreciate this drug information question and will follow up within 72 hours with any further questions.
Please read those articles and make they are correctly referenced.
References
- Dillon, R. C., Merchan, C., Altshuler, D., & Papadopoulos, J. (2018). Incidence of Adverse Events During Peripheral Administration of Sodium Chloride 3%. Journal of Intensive Care Medicine, 33(1), 48–53.
- Perez, C., & Figueroa, S. (n.d.). Complication Rates of 3% Hypertonic Saline Infusion Through Peripheral Intravenous Access. Journal of Neuroscience Nursing, 49(3)(0888-0395), 191–195. doi: 10.1097/JNN.0000000000000286
- Mesghali, E., Fitter, S., Bahjri, K., & Moussavi, K. (n.d.). Safety of Peripheral Line Administration of 3% Hypertonic Saline and Mannitol in the Emergency Department. The Journal of Emergency Medicine, 56(4), 431–436.
- Lexicomp® AHFS Drug Information®. © Copyright, 1959-2020, Selected Revisions January 1, 2009, American Society of Health-System Pharmacists®, 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814.
Example of a well written Drug Information question response:
- As long as my paper looks like this (format and answers all the rubric question I’m happy)
RUBRIC
QUALITY OF RESPONSE |
NO RESPONSE |
POOR / UNSATISFACTORY |
SATISFACTORY |
GOOD |
EXCELLENT |
Content (worth a maximum of 50% of the total points) |
Zero points: Student failed to submit the final paper. |
20 points out of 50: The essay illustrates poor understanding of the relevant material by failing to address or incorrectly addressing the relevant content; failing to identify or inaccurately explaining/defining key concepts/ideas; ignoring or incorrectly explaining key points/claims and the reasoning behind them; and/or incorrectly or inappropriately using terminology; and elements of the response are lacking. |
30 points out of 50: The essay illustrates a rudimentary understanding of the relevant material by mentioning but not full explaining the relevant content; identifying some of the key concepts/ideas though failing to fully or accurately explain many of them; using terminology, though sometimes inaccurately or inappropriately; and/or incorporating some key claims/points but failing to explain the reasoning behind them or doing so inaccurately. Elements of the required response may also be lacking. |
40 points out of 50: The essay illustrates solid understanding of the relevant material by correctly addressing most of the relevant content; identifying and explaining most of the key concepts/ideas; using correct terminology; explaining the reasoning behind most of the key points/claims; and/or where necessary or useful, substantiating some points with accurate examples. The answer is complete. |
50 points: The essay illustrates exemplary understanding of the relevant material by thoroughly and correctly addressing the relevant content; identifying and explaining all of the key concepts/ideas; using correct terminology explaining the reasoning behind key points/claims and substantiating, as necessary/useful, points with several accurate and illuminating examples. No aspects of the required answer are missing. |
Use of Sources (worth a maximum of 20% of the total points). |
Zero points: Student failed to include citations and/or references. Or the student failed to submit a final paper. |
5 out 20 points: Sources are seldom cited to support statements and/or format of citations are not recognizable as APA 6th Edition format. There are major errors in the formation of the references and citations. And/or there is a major reliance on highly questionable. The Student fails to provide an adequate synthesis of research collected for the paper. |
10 out 20 points: References to scholarly sources are occasionally given; many statements seem unsubstantiated. Frequent errors in APA 6th Edition format, leaving the reader confused about the source of the information. There are significant errors of the formation in the references and citations. And/or there is a significant use of highly questionable sources. |
15 out 20 points: Credible Scholarly sources are used effectively support claims and are, for the most part, clear and fairly represented. APA 6th Edition is used with only a few minor errors. There are minor errors in reference and/or citations. And/or there is some use of questionable sources. |
20 points: Credible scholarly sources are used to give compelling evidence to support claims and are clearly and fairly represented. APA 6th Edition format is used accurately and consistently. The student uses above the maximum required references in the development of the assignment. |
Grammar (worth maximum of 20% of total points) |
Zero points: Student failed to submit the final paper. |
5 points out of 20: The paper does not communicate ideas/points clearly due to inappropriate use of terminology and vague language; thoughts and sentences are disjointed or incomprehensible; organization lacking; and/or numerous grammatical, spelling/punctuation errors |
10 points out 20: The paper is often unclear and difficult to follow due to some inappropriate terminology and/or vague language; ideas may be fragmented, wandering and/or repetitive; poor organization; and/or some grammatical, spelling, punctuation errors |
15 points out of 20: The paper is mostly clear as a result of appropriate use of terminology and minimal vagueness; no tangents and no repetition; fairly good organization; almost perfect grammar, spelling, punctuation, and word usage. |
20 points: The paper is clear, concise, and a pleasure to read as a result of appropriate and precise use of terminology; total coherence of thoughts and presentation and logical organization; and the essay is error free. |
Structure of the Paper (worth 10% of total points) |
Zero points: Student failed to submit the final paper. |
3 points out of 10: Student needs to develop better formatting skills. The paper omits significant structural elements required for and APA 6th edition paper. Formatting of the paper has major flaws. The paper does not conform to APA 6th edition requirements whatsoever. |
5 points out of 10: Appearance of final paper demonstrates the student’s limited ability to format the paper. There are significant errors in formatting and/or the total omission of major components of an APA 6th edition paper. They can include the omission of the cover page, abstract, and page numbers. Additionally the page has major formatting issues with spacing or paragraph formation. Font size might not conform to size requirements. The student also significantly writes too large or too short of and paper |
7 points out of 10: Research paper presents an above-average use of formatting skills. The paper has slight errors within the paper. This can include small errors or omissions with the cover page, abstract, page number, and headers. There could be also slight formatting issues with the document spacing or the font Additionally the paper might slightly exceed or undershoot the specific number of required written pages for the assignment. |
10 points: Student provides a high-caliber, formatted paper. This includes an APA 6th edition cover page, abstract, page number, headers and is double spaced in 12’ Times Roman Font. Additionally, the paper conforms to the specific number of required written pages and neither goes over or under the specified length of the paper. |
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