Optimization of intravenous administration of hydroxocobalamin in pediatric emergencies - HYDROX-OPTIMIS study

Introduction: Procedures to prepare and infuse intravenous drugs are poorly documented.Objective: To determinate the optimal mode of hydroxocobalamin administration in children in emergency care. Methods: We identified three modes of administration: (1) connect infusion tubing to the vial, start the infusion and interrupt it when the desired dose has been delivered; (2) remove from the vial the volume corresponding to the excessive dose and connect infusion tubing and (3) extract from the vial the required volume to be delivered and infuse directly. Experimental study: 25 nurses performed each of these three procedures for children weighting 15 and 30 kg. Speed and precision were primary end-points; ease, safety and drug economy were secondary end-points.Results: Mode 3 was the fastest (42[37-61] sec) followed by modes 1 and 2 (p < 0.05). Mode 3 was the most precise (100[100-100]%) followed by modes 1 and 2 (p = 0.001). Mode 3 was the easiest (10.0[9.0-10.0]) followed by modes 2 and 3 (p = 0.001). Modes 1 and 3 allowed administration of a second dose whereas mode 2 did not.Conclusion: Taking the required volume from the vial and infuse directly was the fastest, the most precise, the easiest and most economical mode of administration. It should be recommended.