Comparison of Three Reconstitution Devices: A Simulated Time and Use Study.

Abstract

The objective of this study was to compare residual volume and time to prepare and reconstitute cefazolin using 3 different reconstitution devices while observing for use errors, participant feedback, and particulate after reconstitution. After demonstrations on the use of each device and practicing twice with each device, participants performed reconstitutions 3 times per device while being timed and observed on device preparation and assembly, mixing the drug with intravenous fluid into vials, and transfer of vial contents into the intravenous bags. Participants completed surveys to assess perceptions on use of each device. Intravenous bags were then hung for 60 minutes and observed for residual fluid and particulate matter. Residual vial volumes ranged from 0.05 mL to 2.6 mL: >0.3 mL in Device 2 (16.7%), Device 1 (55.6%), and Device 3 (81.1%). Most participants (83%) had experience with Device 1. Mean (standard deviation) total time in seconds to reconstitute medication significantly differed between devices (P<0.001): Device 1, 70.98 (15.72), Device 2, 99.11 (14.87), Device 3, 103.7 (18.99). Device assembly took the longest time and significantly differed between devices (P<0.001): Device 1, 18.76 (8.13), Device 2, 36.09 (8.05), and Device 3, 31.21 (7.75). Survey results (60=max score) were significantly different (P<0.001): Device 1, 54.5 (5.3), Device 2, 44 (13.1), Device 3, 37.1 (9.1). Nurses ranked Device 1 the highest (79%) and pharmacy technicians favored Device 2 (60%). No particulates were found (n = 270). Potentially significant residual vial volume was found and use errors were concerning in Device 2 and Device 3, potentially resulting in incomplete medication dosing. Mean times for reconstitution were <104 seconds, with Device 1 being the fastest and most favored.