{"id":8095,"date":"2024-09-02T10:00:36","date_gmt":"2024-09-02T08:00:36","guid":{"rendered":"https:\/\/eu.bd.com\/iv-news\/?p=8095"},"modified":"2024-07-29T11:42:41","modified_gmt":"2024-07-29T09:42:41","slug":"osmolarite-du-liquide-iv-ce-quil-faut-savoir-pour-la-selection-dun-catheter-iv","status":"publish","type":"post","link":"https:\/\/eu.bd.com\/iv-news\/fr\/actualites-et-innovation\/osmolarite-du-liquide-iv-ce-quil-faut-savoir-pour-la-selection-dun-catheter-iv\/","title":{"rendered":"Osmolarit\u00e9 du liquide IV : ce qu\u2019il faut savoir pour la s\u00e9lection d\u2019un cath\u00e9ter IV"},"content":{"rendered":"

Plusieurs crit\u00e8res de s\u00e9lection aident \u00e0 d\u00e9terminer le dispositif d’acc\u00e8s vasculaire (DAV) appropri\u00e9 pour votre patient.1<\/sup> Ceux-ci comprennent, entre autres, le type de traitement, la dur\u00e9e, l’\u00e2ge, les comorbidit\u00e9s et la sant\u00e9 vasculaire.1 <\/sup>Comprendre \u00e0 la fois l’anatomie et la physiologie du syst\u00e8me vasculaire peut vous aider \u00e0 faire de bons choix en mati\u00e8re d’acc\u00e8s vasculaire afin de r\u00e9duire le risque de complications intraveineuses (IV) et de garantir la s\u00e9curit\u00e9 du patient.1<\/sup><\/p>\n

L\u2019osmolarit\u00e9 du liquide IV est un facteur important \u00e0 prendre en compte lors de la s\u00e9lection du cath\u00e9ter IV appropri\u00e9 pour votre patient. Les perfusions avec un pH ou des niveaux d\u2019osmolarit\u00e9 incorrects entra\u00eenent souvent une phl\u00e9bite.2<\/sup> Celles pr\u00e9sentant une osmolarit\u00e9 tr\u00e8s \u00e9lev\u00e9e ou tr\u00e8s faible peuvent \u00e9galement entra\u00eener une infiltration ou une extravasation.3<\/sup><\/p>\n

Plus loin dans cet article, nous discuterons des moyens de vous aider \u00e0 pr\u00e9venir ces complications IV en ce qui concerne l\u2019osmolarit\u00e9. Mais d\u2019abord, d\u00e9finissons plusieurs termes.<\/p>\n

D\u00e9finitions de l\u2019osmolarit\u00e9<\/h2>\n

Qu\u2019est-ce que l\u2019osmolarit\u00e9 au juste\u00a0? Selon les normes de pratique du traitement par perfusion de l\u2019Infusion Nurses Society (INS) 2024 l\u2019osmolarit\u00e9 est d\u00e9finie comme \u00e9tant \u00ab\u00a0le nombre de particules osmotiquement actives dans une solution\u00a0\u00bb.1<\/sup><\/p>\n

Lorsqu’un liquide IV contient une concentration osmotique sup\u00e9rieure \u00e0 celle des cellules sanguines, il est consid\u00e9r\u00e9 comme hypertonique.1<\/sup> Les solutions IV hypertoniques peuvent entra\u00eener une diminution des cellules sanguines et endoth\u00e9liales.2<\/sup> Parmi les exemples de solutions hypertoniques figurent l’injection de dextrose \u00e0 5\u00a0% et de chlorure de sodium \u00e0 0,9\u00a0%, les solutions d’acides amin\u00e9s, l’injection de dextrose \u00e0 50\u00a0% et la solution de chlorure de potassium (2\u00a0mEq\/mL).2<\/sup><\/p>\n

\u00c0 l’autre extr\u00e9mit\u00e9 du spectre d’osmolarit\u00e9 se trouvent\u00a0 des solutions hypotoniques ou ayant une concentration osmotique inf\u00e9rieure \u00e0 celle des cellules.1<\/sup> Les solutions IV hypotoniques peuvent provoquer l’\u00e9largissement et l’\u00e9clatement des cellules sanguines et endoth\u00e9liales.2<\/sup> Parmi les exemples de solutions hypotoniques figurent la solution de chlorure de sodium \u00e0 0,45\u00a0% et l’eau st\u00e9rile pour injection.2<\/sup><\/p>\n

Le plasma sanguin contient un niveau d\u2019osmolarit\u00e9 d\u2019environ 290\u00a0mOsm\/L. Si la solution IV pr\u00e9sente un niveau d\u2019osmolarit\u00e9 plus \u00e9lev\u00e9, cela peut entra\u00eener une irritation, des l\u00e9sions endoth\u00e9liales, une phl\u00e9bite ou m\u00eame des caillots sanguins.4<\/sup><\/p>\n

Id\u00e9alement, le liquide que vous administrez par voie intraveineuse \u00e0 vos patients doit \u00eatre isotonique, ce qui signifie qu’il a la m\u00eame concentration osmotique que les cellules.1<\/sup> Par exemple, une solution saline \u00e0 0,9\u00a0% est consid\u00e9r\u00e9e comme isotonique.2<\/sup><\/p>\n

Plus d\u2019informations \u00e0 ce sujet : <\/strong>3\u202ffacteurs \u00e0 prendre en compte lors de la s\u00e9lection d\u2019un dispositif d\u2019acc\u00e8s vasculaire<\/a><\/p>\n

Osmolarit\u00e9 du liquide IV\u00a0: Quelles sont les limites pour les m\u00e9dicaments IV\u00a0?<\/h2>\n

Comment l\u2019osmolarit\u00e9 influence-t-elle la s\u00e9lection des cath\u00e9ters\u00a0? Diff\u00e9rentes directives\u00a0 fixent des seuils d’osmolarit\u00e9 diff\u00e9rents entre les dispositifs d’acc\u00e8s vasculaire p\u00e9riph\u00e9rique (DAVP) et les dispositifs d’acc\u00e8s vasculaire\u00a0 centraux (DAVC).1,5<\/sup><\/p>\n

Les recommandations europ\u00e9ennes pour une indication et une utilisation correctes de l\u2019acc\u00e8s vasculaire p\u00e9riph\u00e9rique (ERPIUP – European Recommendations for Proper Indication and Use of Peripheral venous access) fixent une limite d\u2019osmolarit\u00e9 de 600\u00a0mOsm\/L pour les m\u00e9dicaments perfus\u00e9s par DAVP.5<\/sup> De plus, le consensus ERPIUP recommande des DAVC pour les m\u00e9dicaments dont les niveaux d\u2019osmolarit\u00e9 sont sup\u00e9rieurs \u00e0 600\u00a0mOsm\/L.5<\/sup><\/p>\n

L’INS d\u00e9conseille l’utilisation de cath\u00e9ters intraveineux p\u00e9riph\u00e9riques courts (CIVP) lors de la perfusion continue d’agents irritants ou v\u00e9sicants.1<\/sup> Si l’osmolarit\u00e9 du m\u00e9dicament est \u00e9lev\u00e9e, elle augmente le risque d’extravasation.6<\/sup><\/p>\n

Osmolarit\u00e9 du liquide IV en nutrition parent\u00e9rale<\/h2>\n

Des niveaux \u00e9lev\u00e9s d\u2019osmolarit\u00e9 dans les m\u00e9langes de nutrition parent\u00e9rale (NP)\u00a0 administr\u00e9s par perfusion p\u00e9riph\u00e9rique peuvent entra\u00eener un risque \u00e9lev\u00e9 de phl\u00e9bite.7<\/sup><\/p>\n

L’osmolarit\u00e9 de tout m\u00e9lange de NP, combin\u00e9e \u00e0 d’autres facteurs, doit \u00eatre calcul\u00e9e avant la s\u00e9lection du cath\u00e9ter IV afin de d\u00e9terminer s’il convient de placer un DAVP ou un DAVC.7<\/sup> La European Society for Clinical Nutrition and Metabolism (ESPEN)<\/a> recommande que la NP p\u00e9riph\u00e9rique ne pr\u00e9sente pas un niveau d’osmolarit\u00e9 sup\u00e9rieur \u00e0 850\u00a0mOsm\/L.8<\/sup><\/p>\n

Le consensus ERPIUP a fix\u00e9 la limite d\u2019osmolarit\u00e9 pour la NP p\u00e9riph\u00e9rique \u00e0
\n800\u2013850\u00a0mOsm\/L.5<\/sup> Les m\u00e9langes de NP\u00a0 d\u00e9passant les limites ESPEN et ERPIUP mentionn\u00e9es ci-dessus doivent de pr\u00e9f\u00e9rence \u00eatre perfus\u00e9s avec des DAVC.5,8<\/sup><\/p>\n

Plus d\u2019informations \u00e0 ce sujet : <\/strong>Une \u00e9quipe espagnole d\u2019acc\u00e8s vasculaire affine l\u2019algorithme de s\u00e9lection des dispositifs<\/a><\/p>\n

Conseil utile\u00a0: plans de posologie<\/h2>\n

\u00c9tant donn\u00e9 que l’osmolarit\u00e9 du liquide IV est un facteur essentiel dans la s\u00e9lection des cath\u00e9ters IV, Ballesteros-Pe\u00f1a et al. recommandent d’utiliser des plans de posologie complets avec\u00a0 les niveaux d’osmolarit\u00e9 pour chaque m\u00e9dicament comme m\u00e9thode possible pour r\u00e9duire le risque potentiel de phl\u00e9bite caus\u00e9e par une osmolarit\u00e9 incorrecte.4<\/sup><\/p>\n

Cependant, les fiches techniques standard des m\u00e9dicaments contiennent des niveaux d\u2019osmolarit\u00e9 pour les m\u00e9dicaments avant dilution et peuvent diff\u00e9rer de l\u2019osmolarit\u00e9 de la formulation finale.1,4<\/sup> C\u2019est pourquoi ils recommandent que ces tableaux contiennent l\u2019osmolarit\u00e9 pour diff\u00e9rentes dilutions.4<\/sup><\/p>\n

Trois recommandations pratiques pour l\u2019osmolarit\u00e9 du liquide IV<\/h2>\n
    \n
  1. Conna\u00eetre les limites d\u2019osmolarit\u00e9 recommand\u00e9es pour les DAVP1,5<\/sup><\/li>\n
  2. V\u00e9rifier l\u2019osmolarit\u00e9 de chaque solution dilu\u00e9e avant la s\u00e9lection du cath\u00e9ter IV4<\/sup><\/li>\n
  3. Envisager d\u2019utiliser des plans de posologie avec les taux d\u2019osmolarit\u00e9 pour chaque m\u00e9dicament4<\/sup><\/li>\n<\/ol>\n

    Outre les caract\u00e9ristiques de perfusion telles que l\u2019osmolarit\u00e9, la compr\u00e9hension de l\u2019anatomie et de la physiologie du syst\u00e8me vasculaire peut vous aider \u00e0 faire de bons choix en mati\u00e8re d\u2019acc\u00e8s vasculaire pour vos patients. Id\u00e9alement, les patients recevront des DAV pour administrer leurs m\u00e9dicaments de mani\u00e8re s\u00fbre et efficace tout au long de leur traitement.<\/p>\n

    Nous avons \u00e9labor\u00e9 cet arbre de d\u00e9cision pour l\u2019\u00e9valuation des dispositifs d\u2019acc\u00e8s vasculaire qui vous guidera dans la s\u00e9lection des cath\u00e9ters IV.<\/p>\n

    T\u00c9L\u00c9CHARGER L\u2019ARBRE DE D\u00c9CISION<\/span><\/a><\/div>\n","protected":false},"excerpt":{"rendered":"

    Plusieurs crit\u00e8res de s\u00e9lection aident \u00e0 d\u00e9terminer le dispositif d’acc\u00e8s vasculaire (DAV) appropri\u00e9 pour votre patient.1 Ceux-ci comprennent, entre autres,…<\/p>\n","protected":false},"author":8,"featured_media":8098,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[748],"tags":[],"class_list":["post-8095","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-actualites-et-innovation","speciality-abord-vasculaire","speciality-securite-du-patient","contenttype-article-fr","target-medecin","target-pharmacie-clinique","target-soins-infirmiers"],"acf":[],"yoast_head":"\nOsmolarit\u00e9 du liquide IV : ce qu\u2019il faut savoir pour la s\u00e9lection d\u2019un cath\u00e9ter IV - BD IV News<\/title>\n<meta name=\"description\" content=\"Explorer le r\u00f4le de l\u2019osmolarit\u00e9 du liquide IV dans la s\u00e9lection des cath\u00e9ters IV pour aider \u00e0 pr\u00e9venir les complications telles que la phl\u00e9bite. T\u00e9l\u00e9chargez votre arbre de d\u00e9cision\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/eu.bd.com\/iv-news\/fr\/actualites-et-innovation\/osmolarite-du-liquide-iv-ce-quil-faut-savoir-pour-la-selection-dun-catheter-iv\/\" \/>\n<meta property=\"og:locale\" content=\"en_GB\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Osmolarit\u00e9 du liquide IV : ce qu\u2019il faut savoir pour la s\u00e9lection d\u2019un cath\u00e9ter IV - BD IV News\" \/>\n<meta property=\"og:description\" content=\"Explorer le r\u00f4le de l\u2019osmolarit\u00e9 du liquide IV dans la s\u00e9lection des cath\u00e9ters IV pour aider \u00e0 pr\u00e9venir les complications telles que la phl\u00e9bite. 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