View in EDS PDF Full Text

Accuracy of tobramycin levels obtained from central venous access devices in patients with cystic fibrosis is technique dependent.

Saved in:
Bibliographic Details
Title: Accuracy of tobramycin levels obtained from central venous access devices in patients with cystic fibrosis is technique dependent.
Authors: Mogayzel PJ Jr. (AUTHOR), Pierce E (AUTHOR), Mills J (AUTHOR), McMahan S (AUTHOR), Carson KA (AUTHOR), McNeil A (AUTHOR), Loehr K (AUTHOR), Joplin R (AUTHOR)
Source: Pediatric Nursing. Nov/Dec2008, Vol. 34 Issue 6, p464-468. 5p.
Abstract: Objective: Patients with cystic fibrosis (CF) frequently require prolonged aminoglycoside antibiotic therapy administered via central venous access devices (CVADs). Therefore, the effect of the volume of saline flush used prior to drawing blood on tobramycin levels obtained from CVADs was investigated to determine the potential for inappropriate drug dosing decisions. Patients and Methods: This was a prospective study comparing tobramycin levels in blood samples obtained Simultaneously from CVADs and from venipuncture. Two saline flushing protocols were tested. During Phase I, CVADs were flushed with 3 mL of normal saline. The saline flush volume was increased to 10 to 20 mL during Phase II. All patients had CF and ranged in age from 10 months to 20 years. Results: Twenty-eight paired peak levels were collected from 19 patients during Phase I of the study, and 30 paired samples were obtained from 20 patients using the revised collection protocol during Phase II. The median (range) peak tobramycin level obtained from CVADs using the original flushing protocol was 13.1 (3.4 to 52.0) compared to 9.5 (3.1 to 46.4) ug/mL for those drawn peripherally. Use of CVAD-obtained levels would have caused inappropriate dosing changes in 43% of cases. Increasing the saline flush volume improved the accuracy of the tobramycin levels obtained from CVADs. Median peak tobramycin levels using the modified flushing protocol were 17.3 (3.6 to 47.0) and 19.0 (3.3 to 42.1) ug/mL obtained from a CVAD or venipuncture, respectively. The intraclass correlation coefficient for this protocol was 0.90 (lower 95% confidence limit; 0.80). Additionally, 87% of these CVAD-obtained levels provided accurate information for clinical decision making. Conclusions: Peak tobramycin levels drawn from CVADs flushed with a small flush volume are falsely elevated compared to those obtained by peripheral venipuncture. The use of a larger saline flush greatly improves the accuracy of these levels. Therefore, care should be taken to base clinical decisions on tobramycin levels obtained by peripheral venipuncture or following an appropriate large volume saline flush. [ABSTRACT FROM AUTHOR]
Copyright of Pediatric Nursing is the property of Jannetti Publications, Inc. and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
URL: 36085308
Database: Education Research Complete
FullText Links:
  – Type: pdflink
Text:
  Availability: 0
Header DbId: ehh
DbLabel: Education Research Complete
An: 105615158
AccessLevel: 6
PubType: Academic Journal
PubTypeId: academicJournal
PreciseRelevancyScore: 0
IllustrationInfo
Items – Name: Title
  Label: Title
  Group: Ti
  Data: Accuracy of tobramycin levels obtained from central venous access devices in patients with cystic fibrosis is technique dependent.
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Mogayzel+PJ+Jr%2E%22">Mogayzel PJ Jr.</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Pierce+E%22">Pierce E</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Mills+J%22">Mills J</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22McMahan+S%22">McMahan S</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Carson+KA%22">Carson KA</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22McNeil+A%22">McNeil A</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Loehr+K%22">Loehr K</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Joplin+R%22">Joplin R</searchLink> (AUTHOR)
– Name: TitleSource
  Label: Source
  Group: Src
  Data: <searchLink fieldCode="JN" term="%22Pediatric+Nursing%22">Pediatric Nursing</searchLink>. Nov/Dec2008, Vol. 34 Issue 6, p464-468. 5p.
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Objective: Patients with cystic fibrosis (CF) frequently require prolonged aminoglycoside antibiotic therapy administered via central venous access devices (CVADs). Therefore, the effect of the volume of saline flush used prior to drawing blood on tobramycin levels obtained from CVADs was investigated to determine the potential for inappropriate drug dosing decisions. Patients and Methods: This was a prospective study comparing tobramycin levels in blood samples obtained Simultaneously from CVADs and from venipuncture. Two saline flushing protocols were tested. During Phase I, CVADs were flushed with 3 mL of normal saline. The saline flush volume was increased to 10 to 20 mL during Phase II. All patients had CF and ranged in age from 10 months to 20 years. Results: Twenty-eight paired peak levels were collected from 19 patients during Phase I of the study, and 30 paired samples were obtained from 20 patients using the revised collection protocol during Phase II. The median (range) peak tobramycin level obtained from CVADs using the original flushing protocol was 13.1 (3.4 to 52.0) compared to 9.5 (3.1 to 46.4) ug/mL for those drawn peripherally. Use of CVAD-obtained levels would have caused inappropriate dosing changes in 43% of cases. Increasing the saline flush volume improved the accuracy of the tobramycin levels obtained from CVADs. Median peak tobramycin levels using the modified flushing protocol were 17.3 (3.6 to 47.0) and 19.0 (3.3 to 42.1) ug/mL obtained from a CVAD or venipuncture, respectively. The intraclass correlation coefficient for this protocol was 0.90 (lower 95% confidence limit; 0.80). Additionally, 87% of these CVAD-obtained levels provided accurate information for clinical decision making. Conclusions: Peak tobramycin levels drawn from CVADs flushed with a small flush volume are falsely elevated compared to those obtained by peripheral venipuncture. The use of a larger saline flush greatly improves the accuracy of these levels. Therefore, care should be taken to base clinical decisions on tobramycin levels obtained by peripheral venipuncture or following an appropriate large volume saline flush. [ABSTRACT FROM AUTHOR]
– Name: AbstractSuppliedCopyright
  Label:
  Group: Ab
  Data: <i>Copyright of Pediatric Nursing is the property of Jannetti Publications, Inc. and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
– Name: URL
  Label: URL
  Group: URL
  Data: <link linkTarget="URL" linkTerm="36085308" linkWindow="_blank">36085308</link>
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=ehh&AN=105615158
RecordInfo BibRecord:
  BibEntity:
    Languages:
      – Code: eng
        Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 5
        StartPage: 464
    Titles:
      – TitleFull: Accuracy of tobramycin levels obtained from central venous access devices in patients with cystic fibrosis is technique dependent.
        Type: main
  BibRelationships:
    HasContributorRelationships:
      – PersonEntity:
          Name:
            NameFull: Mogayzel PJ Jr.
      – PersonEntity:
          Name:
            NameFull: Pierce E
      – PersonEntity:
          Name:
            NameFull: Mills J
      – PersonEntity:
          Name:
            NameFull: McMahan S
      – PersonEntity:
          Name:
            NameFull: Carson KA
      – PersonEntity:
          Name:
            NameFull: McNeil A
      – PersonEntity:
          Name:
            NameFull: Loehr K
      – PersonEntity:
          Name:
            NameFull: Joplin R
    IsPartOfRelationships:
      – BibEntity:
          Dates:
            – D: 01
              M: 11
              Text: Nov/Dec2008
              Type: published
              Y: 2008
          Identifiers:
            – Type: issn-print
              Value: 00979805
          Numbering:
            – Type: volume
              Value: 34
            – Type: issue
              Value: 6
          Titles:
            – TitleFull: Pediatric Nursing
              Type: main
ResultId 1