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Abstract
Background: Phlebitis is a common side effect of vancomycin peripheral intravenous (PIV) infusion. As only one PIV catheter is frequently used to deliver several drugs to hospitalized patients through the same Y-site, perturbation of the infusion flow by hydration or other IV medication may influence vancomycin exposure to endothelial cells and modulate toxicity. Methods: We assessed the toxicity of variations in vancomycin concentration induced by drug mass flow variations in human umbilical vein endothelial cells (HUVECs), simulating a 24 h multi-infusion therapy on the same line. Results were expressed as the percentage of viable cells compared with a 100% control, and the Kruskal–Wallis test was used to assess the toxicity of vancomycin. Results: Our results showed that variations in vancomycin concentration did not significantly influence local toxicity compared to a fixed concentration of vancomycin. Nevertheless, the loss of cell viability induced by mechanical trauma mimicking multidrug infusion could increase the risk of phlebitis. Conclusion: To ensure that vancomycin-induced phlebitis must have other causes than variation in drug mass flow, further in vitro experiments should be performed to limit mechanical stress to frequent culture medium change.
Highlights
An Iranian study showed that the frequency of occurrence of phlebitis in children treated with vancomycin was dependent on the infusion modality (45.90 and 89.10%) [4]
The aim of this study was to assess the toxicity of assess the toxicity of variations in vancomycin concentration under in vitro conditions variations in vancomycin concentration under in vitro conditions simulating multi-infusion simulating multi-infusion on line the same line to determine whether vancomycin rate increase local on the same to determine whether vancomycin flow rate flow variations variations increase local endothelial toxicity
Our result showed vancomycin at a fixed concentration for 24concentration h in a Ourthat result showed maintained that vancomycin maintained at a fixed for 24 h culture medium in of human umbilical vein cells (HUVECs) caused a concentraa culture medium of endothelial human umbilical vein endothelial cells (HUVECs) caused a tion-dependent loss of cell viability of aboutloss
Summary
An Iranian study showed that the frequency of occurrence of phlebitis in children treated with vancomycin was dependent on the infusion modality (45.90 and 89.10%) [4]. This treatment causes concentration-dependent phlebitis: it appears to be less frequent when administered at a concentration below 5 mg/mL and better tolerated at a final concentration of. As only one PIV catheter is frequently used to deliver several drugs to hospitalized patients through the same Y-site, perturbation of the infusion flow by hydration or other IV medication may influence vancomycin exposure to endothelial cells and modulate toxicity. Conclusion: To ensure that vancomycin-induced phlebitis must have other causes than variation in drug mass flow, further in vitro experiments should be performed to limit mechanical stress to frequent culture medium change
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