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Otero-Millán L, Bea-Mascato B, Legido Soto JL, Martínez-López-De-Castro N, Lago Rivero N. Electron Microscopy for the Stability Assessment of Parenteral Nutrition Admixtures: Focus on Precipitation. Nutrients 2024; 16:1390. [PMID: 38732636 PMCID: PMC11085670 DOI: 10.3390/nu16091390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 04/30/2024] [Accepted: 05/01/2024] [Indexed: 05/13/2024] Open
Abstract
(1) Background: parenteral nutrition (PN) is indispensable for patients unable to receive oral or enteral feeding. However, the complexity of PN solutions presents challenges regarding stability and compatibility. Precipitation reactions may occur. The most frequent is the formation of calcium phosphate (Ca-P). The different factors influencing these reactions must be considered to ensure patient safety. (2) Methods: eight paediatric PN solutions were prepared, following standard protocols. Samples were stored at room temperature and in a refrigerator. Electron microscopy, coupled with energy dispersive X-ray spectroscopy (EDS), was employed. Precipitates were analysed for composition and morphology. (3) Results: precipitates were observed in all samples, even at day 0. Crystalline structures, predominantly composed of calcium or magnesium, sometimes associated with chlorine or phosphorus, were detected. Additionally, amorphous precipitates, contained heterogeneous compositions, including unexpected elements, were identified. (4) Conclusions: various precipitates, primarily calcium- or magnesium-based, can form in PN solutions, although it is not expected that they can form under the real conditions of use. Calcium oxalate precipitation has been characterised, but the use of organic calcium and phosphate salts appears to mitigate calcium phosphate precipitation. Electron microscopy provides interesting results on NP precipitation, but sample preparation may present technical limitations that affect the interpretation of the results.
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Affiliation(s)
- Luis Otero-Millán
- Pharmacy Department, University Hospital Complex of Vigo, 36312 Vigo, Spain;
- NeumoVigo I+i Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur) SERGAS-UVIGO, 36312 Vigo, Spain
| | - Brais Bea-Mascato
- Innovation in Clinical Pharmacy Research Group (i-FARMA-Vigo), Galicia Sur Health Research Institute (IIS Galicia Sur) SERGAS-UVIGO, 36312 Vigo, Spain;
| | - Jose Luis Legido Soto
- Applied Physic Department, Faculty of Sciences, University of Vigo, 36310 Vigo, Spain;
| | - Noemi Martínez-López-De-Castro
- Pharmacy Department, University Hospital Complex of Vigo, 36312 Vigo, Spain;
- Innovation in Clinical Pharmacy Research Group (i-FARMA-Vigo), Galicia Sur Health Research Institute (IIS Galicia Sur) SERGAS-UVIGO, 36312 Vigo, Spain;
| | - Natividad Lago Rivero
- Pharmacy Department, University Hospital Complex of Vigo, 36312 Vigo, Spain;
- Innovation in Clinical Pharmacy Research Group (i-FARMA-Vigo), Galicia Sur Health Research Institute (IIS Galicia Sur) SERGAS-UVIGO, 36312 Vigo, Spain;
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Van Boxtel T, Pittiruti M, Arkema A, Ball P, Barone G, Bertoglio S, Biffi R, Dupont C, Fonzo-Christe C, Foster J, Jones M, Keck C, Ray-Barruel G, Sasse M, Scoppettuolo G, Van Den Hoogen A, Villa G, Hadaway L, Ryder M, Schears G, Stone J. WoCoVA consensus on the clinical use of in-line filtration during intravenous infusions: Current evidence and recommendations for future research. J Vasc Access 2021; 23:179-191. [PMID: 33506747 DOI: 10.1177/1129729821989165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The need for filtering intravenous infusions has long been recognized in the field of venous access, though hard scientific evidence about the actual indications for in-line filters has been scarce. In the last few years, several papers and a few clinical studies have raised again this issue, suggesting that the time has come for a proper definition of the type of filtration, of its potential benefit, and of its proper indications in clinical practice. The WoCoVA Foundation, whose goal is to increase the global awareness on the risk of intravenous access and on patients' safety, developed the project of a consensus on intravenous filtration. A panel of experts in different aspects of intravenous infusion was chosen to express the current state of knowledge about filtration and to indicate the direction of future research in this field. The present document reports the final conclusions of the panel.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Jann Foster
- Western Sydney University, Sydney, Australia
| | - Matthew Jones
- East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
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Worthington P, Gura KM, Kraft MD, Nishikawa R, Guenter P, Sacks GS. Update on the Use of Filters for Parenteral Nutrition: An ASPEN Position Paper. Nutr Clin Pract 2020; 36:29-39. [DOI: 10.1002/ncp.10587] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 09/04/2020] [Accepted: 09/15/2020] [Indexed: 01/05/2023] Open
Affiliation(s)
- Patricia Worthington
- Department of Nursing Thomas Jefferson University Hospital Philadelphia Pennsylvania USA
| | - Kathleen M. Gura
- Pharmacy Clinical Research Program Boston Children's Hospital Harvard Medical School Boston Massachusetts USA
| | - Michael D. Kraft
- Department of Pharmacy Services Education and Research–Michigan Medicine University of Michigan College of Pharmacy Ann Arbor Michigan USA
| | | | - Peggi Guenter
- Clinical Practice Quality and Advocacy American Society for Parenteral and Enteral Nutrition Silver Spring Maryland USA
| | - Gordon S. Sacks
- Medical Affairs for PN Market Unit Fresenius Kabi USA, LLC Lake Zurich Illinois USA
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Villa G, Giua R, Amass T, Tofani L, Chelazzi C, Pinelli F, De Gaudio AR, Romagnoli S. In-line filtration reduced phlebitis associated with peripheral venous cannulation: Focus on cost-effectiveness and patients' perspectives. J Vasc Access 2019; 21:154-160. [PMID: 31347438 DOI: 10.1177/1129729819861187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In a previous trial, in-line filtration significantly prevented postoperative phlebitis associated with short peripheral venous cannulation. This study aims to describe the cost-effectiveness of in-line filtration in reducing phlebitis and examine patients' perception of in-hospital vascular access management with and without in-line filtration. METHODS We analysed costs associated with in-line filtration: these data were prospectively recorded during the previous trial. Furthermore, we performed a follow-up for all the 268 patients enrolled in this trial. Among these, 213 patients responded and completed 6 months after hospital discharge questionnaires evaluating the perception of and satisfaction with the management of their vascular access. RESULTS In-line filtration group required 95.60€ more than the no-filtration group (a mean of € 0.71/patient). In terms of satisfaction with the perioperative management of their short peripheral venous cannulation, 110 (82%) and 103 (76.9%) patients, respectively, for in-line filtration and control group, completed this survey. Within in-line filtration group, 97.3% of patients were satisfied/strongly satisfied; if compared with previous experiences on short peripheral venous cannulation, 11% of them recognised in-line filtration as a relevant causative factor in determining their satisfaction. Among patients within the control group, 93.2% were satisfied/strongly satisfied, although up to 30% of them had experienced postoperative phlebitis. At the qualitative interview, they recognised no difference than previous experiences on short peripheral venous cannulation, and mentioned postoperative phlebitis as a common event that 'normally occurs' during a hospital stay. CONCLUSION In-line filtration is cost-effective in preventing postoperative phlebitis, and it seems to contribute to increasing patient satisfaction and reducing short peripheral venous cannulation-related discomfort.
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Affiliation(s)
- Gianluca Villa
- Department of Health Sciences, Section of Anesthesia, Intensive Care and Pain Medicine, University of Florence, Florence, Italy.,Department of Anesthesia and Intensive Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Rosa Giua
- Department of Anesthesia and Intensive Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Timothy Amass
- Division of Pulmonary Critical Care & Sleep, Department of Medicine, Brown University, Providence, RI, USA
| | - Lorenzo Tofani
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Cosimo Chelazzi
- Department of Anesthesia and Intensive Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Fulvio Pinelli
- Department of Anesthesia and Intensive Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - A Raffaele De Gaudio
- Department of Health Sciences, Section of Anesthesia, Intensive Care and Pain Medicine, University of Florence, Florence, Italy.,Department of Anesthesia and Intensive Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Stefano Romagnoli
- Department of Health Sciences, Section of Anesthesia, Intensive Care and Pain Medicine, University of Florence, Florence, Italy.,Department of Anesthesia and Intensive Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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Villa G, Chelazzi C, Giua R, Tofani L, Zagli G, Boninsegni P, Pinelli F, De Gaudio AR, Romagnoli S. In-Line Filtration Reduces Postoperative Venous Peripheral Phlebitis Associated With Cannulation. Anesth Analg 2018; 127:1367-1374. [DOI: 10.1213/ane.0000000000003393] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Hartman C, Shamir R, Simchowitz V, Lohner S, Cai W, Decsi T, Braegger C, Bronsky J, Cai W, Campoy C, Carnielli V, Darmaun D, Decsi T, Domellöf M, Embleton N, Fewtrell M, Fidler Mis N, Franz A, Goulet O, Hartman C, Hill S, Hojsak I, Iacobelli S, Jochum F, Joosten K, Kolaček S, Koletzko B, Ksiazyk J, Lapillonne A, Lohner S, Mesotten D, Mihályi K, Mihatsch WA, Mimouni F, Mølgaard C, Moltu SJ, Nomayo A, Picaud JC, Prell C, Puntis J, Riskin A, Saenz De Pipaon M, Senterre T, Shamir R, Simchowitz V, Szitanyi P, Tabbers MM, Van Den Akker CH, Van Goudoever JB, Van Kempen A, Verbruggen S, Wu J, Yan W. ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Complications. Clin Nutr 2018; 37:2418-2429. [DOI: 10.1016/j.clnu.2018.06.956] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 06/12/2018] [Indexed: 12/30/2022]
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7
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Chau CT, Prielipp RC, Wahr JA. Prevention of Thrombophlebitis in Peripheral Intravenous Catheters: The Butterfly Effect. Anesth Analg 2018; 127:1287-1288. [PMID: 30433918 DOI: 10.1213/ane.0000000000003764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Chen Thay Chau
- From the Department of Anesthesiology, University of Minnesota, Minneapolis, Minnesota
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Benlabed M, Perez M, Gaudy R, Genay S, Lannoy D, Barthélémy C, Odou P, Lebuffe G, Décaudin B. Clinical implications of intravenous drug incompatibilities in critically ill patients. Anaesth Crit Care Pain Med 2018; 38:173-180. [PMID: 29680262 DOI: 10.1016/j.accpm.2018.04.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Revised: 01/06/2018] [Accepted: 04/05/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE The aim of this review is to analyse the clinical consequences of intravenous drug incompatibilities in critically ill patients, especially the incidence of organ dysfunctions and mortality. METHODS A review of literature was conducted according to the PRISMA statement in June 2017, using Medline, ISI Web of Science and Clinicaltrials.gov. DATA EXTRACTION Eligible studies were case reports and randomised controlled trials (RCTs) that assessed the effects of drug incompatibilities in critically ill patients on morbidity or mortality as primary or secondary outcomes, or adverse events. Two investigators independently reviewed the eligibility of the study from abstracts or manuscript data. DATA SYNTHESIS Twelve articles met the selection criteria. The six articles reporting RCTs concern only four RCTs. RCTs were single-centre studies comparing infusion with or without filter. One of them included adult patients. The others included paediatric and neonatal intensive care unit patients. Primary endpoints were SIRS, organ failure, overall complication rate, bacteraemia, sepsis, phlebitis and length of stay. The results are mixed with one RCT reporting a reduction in SIRS, organ failure and overall complication rate, two studies in disagreement over the occurrence of sepsis and one study reporting no impact on length of hospital stay. The six articles on case reports show different drug incompatibility situations. They report pulmonary toxicity. CONCLUSION Little data is available on this topic. Infused particles may induce organ failure, in particular pulmonary toxicity and SIRS. Further studies are needed to establish a link between the level of exposure to drug incompatibilities and clinical implication.
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Affiliation(s)
- Malik Benlabed
- Groupe de recherche sur les formes injectables et les technologies associées (GRITA), University Lille, EA 7365, 59000 Lille, France
| | - Maxime Perez
- Groupe de recherche sur les formes injectables et les technologies associées (GRITA), University Lille, EA 7365, 59000 Lille, France; Pharmacie, CHU de Lille, 59000 Lille, France
| | - Romain Gaudy
- Groupe de recherche sur les formes injectables et les technologies associées (GRITA), University Lille, EA 7365, 59000 Lille, France
| | - Stéphanie Genay
- Groupe de recherche sur les formes injectables et les technologies associées (GRITA), University Lille, EA 7365, 59000 Lille, France; Pharmacie, CHU de Lille, 59000 Lille, France
| | - Damien Lannoy
- Groupe de recherche sur les formes injectables et les technologies associées (GRITA), University Lille, EA 7365, 59000 Lille, France; Pharmacie, CHU de Lille, 59000 Lille, France
| | - Christine Barthélémy
- Groupe de recherche sur les formes injectables et les technologies associées (GRITA), University Lille, EA 7365, 59000 Lille, France
| | - Pascal Odou
- Groupe de recherche sur les formes injectables et les technologies associées (GRITA), University Lille, EA 7365, 59000 Lille, France; Pharmacie, CHU de Lille, 59000 Lille, France
| | - Gilles Lebuffe
- Groupe de recherche sur les formes injectables et les technologies associées (GRITA), University Lille, EA 7365, 59000 Lille, France; Pôle d'anesthésie-réanimation, CHU de Lille, 59000 Lille, France
| | - Bertrand Décaudin
- Groupe de recherche sur les formes injectables et les technologies associées (GRITA), University Lille, EA 7365, 59000 Lille, France; Pharmacie, CHU de Lille, 59000 Lille, France.
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Al Salloum H, Saunier J, Dazzi A, Vigneron J, Etcheberry A, Marlière C, Aymes-Chodur C, Herry JM, Bernard M, Jubeli E, Yagoubi N. Characterization of the surface physico-chemistry of plasticized PVC used in blood bag and infusion tubing. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2017; 75:317-334. [PMID: 28415468 DOI: 10.1016/j.msec.2017.02.057] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 11/28/2016] [Accepted: 02/14/2017] [Indexed: 10/20/2022]
Abstract
Commercial infusion tubing and blood storage devices (tubing, blood and platelets bags) made of plasticized PVC were analyzed by spectroscopic, chromatographic and microscopic techniques in order to identify and quantify the additives added to the polymer (lubricants, thermal stabilizers, plasticizers) and to put into evidence their blooming onto the surface of the devices. For all the samples, deposits were observed on the surface but with different kinds of morphologies. Ethylene bis amide lubricant and metallic stearate stabilizers were implicated in the formation of these layers. In contact with aqueous media, these insoluble deposits were damaged, suggesting a possible particulate contamination of the infused solutions.
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Affiliation(s)
- H Al Salloum
- IFR 141, EA 401, UFR de Pharmacie, Univ. Paris Sud - Université Paris-Saclay, 92290 Chatenay Malabry, France
| | - J Saunier
- IFR 141, EA 401, UFR de Pharmacie, Univ. Paris Sud - Université Paris-Saclay, 92290 Chatenay Malabry, France.
| | - A Dazzi
- LCP, CNRS-UMR8000, Univ. Paris-Sud, Université Paris-Saclay, 91405 Orsay, France
| | - J Vigneron
- ILV, CNRS, UVSQ, Université Paris-Saclay, 45 Avenue des Etats Unis, 78035 Versailles, France
| | - A Etcheberry
- ILV, CNRS, UVSQ, Université Paris-Saclay, 45 Avenue des Etats Unis, 78035 Versailles, France
| | - C Marlière
- ISMO, UMR CNRS 8214, Univ. Paris Sud, Université Paris-Saclay, 91405 Orsay cedex, France
| | - C Aymes-Chodur
- IFR 141, EA 401, UFR de Pharmacie, Univ. Paris Sud - Université Paris-Saclay, 92290 Chatenay Malabry, France
| | - J M Herry
- Micalis Institute, INRA, AgroParisTech, Université Paris-Saclay, 78350 Jouy-en-Josas, France
| | - M Bernard
- IFR 141, EA 401, UFR de Pharmacie, Univ. Paris Sud - Université Paris-Saclay, 92290 Chatenay Malabry, France
| | - E Jubeli
- IFR 141, EA 401, UFR de Pharmacie, Univ. Paris Sud - Université Paris-Saclay, 92290 Chatenay Malabry, France
| | - N Yagoubi
- IFR 141, EA 401, UFR de Pharmacie, Univ. Paris Sud - Université Paris-Saclay, 92290 Chatenay Malabry, France
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Fonzo-Christe C, Bouchoud L, Pfister R. Incompatibilités médicamenteuses et nutrition parentérale en néonatologie. NUTR CLIN METAB 2017. [DOI: 10.1016/j.nupar.2016.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Perez M, Maiguy-Foinard A, Barthélémy C, Décaudin B, Odou P. Particulate Matter in Injectable Drugs: Evaluation of Risks to Patients. PHARMACEUTICAL TECHNOLOGY IN HOSPITAL PHARMACY 2016. [DOI: 10.1515/pthp-2016-0004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
AbstractOne of the fundamental principles guiding the pharmaceutical quality of parenteral products is to prevent injecting contaminants from microbiological, chemical or physical sources. It is just as difficult to ensure the absence of chemical and particulate contaminants in injectable products as it is to weigh up the microbiological risk. The problem of particulate matter is mainly related to the preparing and administrating of injectable drugs rather than through the contamination of marketed products. Particulate contamination also arises
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Perez M, Décaudin B, Abou Chahla W, Nelken B, Barthélémy C, Lebuffe G, Odou P. In vitro analysis of overall particulate contamination exposure during multidrug IV therapy: impact of infusion sets. Pediatr Blood Cancer 2015; 62:1042-7. [PMID: 25755136 DOI: 10.1002/pbc.25442] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 01/02/2015] [Indexed: 12/24/2022]
Abstract
BACKGROUND Drug incompatibilities, recognizable through precipitate, may have clinical consequences for patients, especially during multidrug IV therapies, where vancomycin and piperacillin are present. Drug concentration and infusion set influence the overall particulate contamination of pediatric infusion protocols. The use of multi-lumen infusion sets could prevent such incompatibilities. Our goal was to define and assess a new way to infuse these drugs during leukemia treatment in children. PROCEDURES This in vitro study focused on a pediatric multidrug protocol for patients diagnosed with lymphoblastic leukemia and receiving allogeneic transplantation. Different vancomycin concentrations were tested to infuse incompatible drugs simultaneously without any particle formation (optimized multidrug protocol). A dynamic particle count test was used over 24 hr to evaluate the overall particulate contamination of our standard and optimized multidrug protocols, using both a standard and a multi-lumen infusion set. RESULTS No visible particles were detected on a decreased vancomycin concentration compared to the standard dose. For the optimized multidrug protocol, the use of a multi-lumen infusion set reduced overall particulate contamination by 68%, compared to the standard infusion set (P = 0.002). Large-sized particles were significantly reduced when using the multi-lumen infusion set approximately 60% (P = 0.027) and 90% (P = 0.009) for particle sizes ≥10 μm and 25 μm, respectively. CONCLUSIONS This study demonstrates that a large number of particles can be administered during parenteral multidrug infusion. The choice of drug concentration and/or the type of infusion set may reduce this. Further studies are required to evaluate adverse clinical effects.
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Affiliation(s)
- Maxime Perez
- EA GRITA, University Lille Nord de France, Lille, France; Institute of Pharmacy, Lille University Hospital, Lille, France
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Sharma DK, King D, Oma P, Merchant C. Micro-flow imaging: flow microscopy applied to sub-visible particulate analysis in protein formulations. AAPS JOURNAL 2010; 12:455-64. [PMID: 20517661 PMCID: PMC2895433 DOI: 10.1208/s12248-010-9205-1] [Citation(s) in RCA: 122] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2009] [Accepted: 05/12/2010] [Indexed: 11/30/2022]
Abstract
The need to monitor, measure, and control sub-visible proteinaceous particulates in biopharmaceutical formulations has been emphasized in recent publications and commentaries. Some of these particulates can be highly transparent, fragile, and unstable. In addition, for much of the size range of concern, no practical measurement method with adequate sensitivity and repeatability has been available. A complication in measuring protein particulates in many formulations is the simultaneous presence of other particle types such as silicone micro-droplets, air bubbles, and extrinsic contaminants. The need has therefore been identified for new analytical methods which can accurately measure and characterize sub-visible particulates in formulations. Micro-flow imaging has been shown to provide high sensitivity in detecting and imaging transparent protein particles and a unique capability to independently analyze such populations even when other particle types are present.
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Affiliation(s)
- Deepak K Sharma
- Brightwell Technologies Inc, 115 Terence Matthews Crescent, Ottawa, Ontario K2M2B2, Canada.
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Gillanders L, Angstmann K, Ball P, Chapman-Kiddell C, Hardy G, Hope J, Smith R, Strauss B, Russell D. AuSPEN clinical practice guideline for home parenteral nutrition patients in Australia and New Zealand. Nutrition 2008; 24:998-1012. [PMID: 18708279 DOI: 10.1016/j.nut.2008.06.004] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2008] [Revised: 06/09/2008] [Accepted: 06/09/2008] [Indexed: 10/21/2022]
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16
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Effect of the Intravenous Lipid Emulsions on the Availability of Calcium when using Organic Phosphate in TPN Admixtures. Pharm Res 2008; 25:2545-54. [DOI: 10.1007/s11095-008-9671-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2008] [Accepted: 06/18/2008] [Indexed: 10/21/2022]
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Beghetto MG, Victorino J, Teixeira L, de Azevedo MJ. Parenteral nutrition as a risk factor for central venous catheter-related infection. JPEN J Parenter Enteral Nutr 2006; 29:367-73. [PMID: 16107600 DOI: 10.1177/0148607105029005367] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The role of parenteral nutrition (PN) therapy as an independent risk factor for central venous catheter (CVC)-related infection in nonselected adult patients is not well established. The aim of this study was to evaluate PN as a risk factor for central venous catheter-related infection in nonselected adult patients in a general university hospital. METHODS Patients using central venous catheters, exposed or nonexposed to PN, were prospectively followed for development of central venous catheter-related infection. RESULTS One hundred fifty-three patients were studied; 28 developed central venous catheter-related infection. Patients with central venous catheter-related infection presented higher frequency of PN use than patients without infection (60.7 vs 34.4%; p = .010). Multivariate Cox analysis showed that PN (relative risk (RR) = 3.30; 95% confidence interval [CI], 1.30-8.34; p = .012) was the only risk factor for central venous catheter-related infection. Malnutrition (RR = 0.45; 95% CI, 0.15-1.34; p = .152), days of hospitalization before central venous catheter insertion (RR = 1.00; 95% CI, 0.98-1.02; p = .801), and sustained hyperglycemia (RR = 0.49; 95% CI, 0.98-1.21; p = .091) were not significant in the model. Multiple logistic regression revealed that mal-nutrition (odds ratio [OR] = 8.05; 95% CI, 1.85-35.03; p = .005), central venous catheter indication for surgical-related pathology (OR = 7.26; 95% CI, 2.51-21.04; p < .001), sustained hyperglycemia (OR = 4.34; 95% CI, 1.79-10.52; p = .001), and days of hospitalization before central venous catheter insertion (OR = 1.04; 95% CI, 1.01-1.07; p = .004) were associated with PN use after adjustment for Assessment Score Intervention System score (OR = 0.33; 95% CI, 0.14-0.80; p = .014). CONCLUSIONS PN therapy is an independent risk factor for central venous catheter-related infection in nonselected hospitalized adult patients.
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Affiliation(s)
- Mariur G Beghetto
- Nursing Division, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Rua Ramiro Barcelos 2350, 90035-003 Porto Alegre, RS, Brazil
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Abstract
PURPOSE OF REVIEW The routine use of intravenous in-line filters on infusion lines has been controversial for many years, with strong advocates, detractors and many fence-sitting observers. The purpose of this review was to examine the literature for new developments and to cast the net a little wider than in previous reviews in an attempt to draw useful parallels. RECENT FINDINGS There were recent major policy statements or recommendations from a working party of the British Pharmaceutical Nutrition Group and from the US Centres for Disease Control. The first was focussed on filters and was broadly in favour, the second was not focussed on the subject but made quite a strong statement against, on microbiological issues alone. The major purpose of filters, however, is particulate contamination, and whilst there was little in the literature directly on this subject, useful parallels could be drawn from papers describing the therapeutic use of particles and also from their effects in intravenous drug users. SUMMARY When all the available information is considered, and the role of filters in particulate contamination, in-line chemical precipitates, identifying problems in parenteral therapy practice, microbial contamination and entrapped air is examined, the case for routine use appears strong.
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Affiliation(s)
- Patrick A Ball
- Department of Clinical Pharmacy, University of Auckland, New Zealand.
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