First experience of continuous infusion of antihemophilic factor in the CHU of Nancy: description of the multi‐field organization and role of pharmacy

Surgical interventions in patients suffering from haemophilia are possible today thanks to the administration of antihemophilic factors (FAH) in curative or preventive treatment of the haemorrhages that could occure in peri‐ and post‐operative period. These drugs are administred in intermittent infusion or in continuous infusion by electric syringe or minipump. This last therapeutic modality showed on optimal clinical effectiveness thanks to obtaining stable plasmatic rates and good tolerance for the patient. In the CHU Brabois adults of Nancy, our experiment of continuous infusion of FAH with minipump is recent. The first surgery with continuous infusion took place only in June 2001. The selected FAH was then Monoclate P ® administred with the minipump Cadd Prizm Vip TM. A multi‐field organization was initiated on this occasion, imposing a good coordination of the whole of participant‘s activities. The aim of this article is to present the role of each of them and to bring back the difficulties encountered within the pharmacy (technical and organisational difficulties). Our experience confirms the feasibility and the advantage, for the patient and the community, of continuous infusion of factor VIII for patient undergoing surgery. Clinical and biological evolution was optimal without difficulty. The treatment‘s duration was shorter. We have estimated that the continuous infusion would permit, during two identical surgery for the same patient, to reduce the doses of factor VIII by about 25%. Nevertheless, this treatment placing needs an important pharmaceutical participation in order to contribute to improve treatment‘s quality. Our working time was important. The gained experience will make it possible to reduce, at the time of next surgery, the working time required by this procedure.