Barium in intravenous solutions for administration to neonates: Origins and levels of contamination

Abstract

Summary Background & aims Barium is a glass constituent and a component of plastic additives, and may migrate from containers and devices into solutions. As barium is a toxic element, all steps involved in the preparation of intravenous solutions for premature neonates in an intensive care unit were evaluated to determine to what degree, if any, they contribute to Ba load. Commercial solutions for parenteral nutrition (PN) and medications and the apparatus used for administration were analyzed for their Ba content. Bags after compounding, medications after their preparation, infusion sets, and syringes were also evaluated. Materials and methods Ba concentration was determined by atomic absorption spectrometry. Results Bags, burettes, syringes, rubber caps, and glass containers yielded Ba in levels ranging from 0.02 to 4.38 mg/g. The highest levels among the solutions were found in multivitamins, magnesium sulfate, and calcium gluconate at 262 μg/L, 193 μg/L, and 166 μg/L, respectively. Most medications did not have measurable Ba contamination. However, after dilution in syringes, all of them became contaminated, and the highest level was reached in dexamethasone samples at 1333 μg/L Ba. Compounded PN bags (n = 15) had a mean of 54.6 μg/L Ba. The content of the same bags after percolating the burette had a mean level of 94.2 μg/L Ba. Conclusion Barium is leached from container materials into solutions parenterally administered to preterm babies. The handling processes of compounding and delivering nutrition solutions and medicines increased the Ba intake by almost 3 fold in relation to its levels in the starting products.