Total Parenteral Nutrient Research Articles

Stability of Imipenem and Cilastatin Sodium in Total Parenteral Nutrient Solution

The chemical stability and compatibility of imipenem-cilastatin sodium (Primaxin) in two different total parenteral nutrient (TPN) solutions was determined. TPN solutions consisted of 4.25% and 5% amino acids with 25% and 35% dextrose, respectively. Imipenem-cilastatin sodium was constituted with 10 ml of sterile water and admixed with 90 ml of TPN solution for a final concentration of 5 mg/ml of each drug. The final solutions were assayed at times 0 (immediately after admixture), 15 min, 30 min, 1, 4, 8, and 24 hr by a stability-indicating high-performance liquid chromatographic assay. Concurrently, test TPN solutions were monitored for pH changes, color changes, and precipitate formation. The potential effect of imipenem-cilastatin sodium on the stability of amino acids and other TPN additives was not evaluated. Imipenem and cilastatin sodium was stable (greater than or equal to 90% recovered) in each TPN solution at 15 min. A significant (greater than or equal to 10%) and steady decrease of imipenem recovery occurred at subsequent sampling times. Cilastatin appeared more stable than imipenem in both TPN solutions. A physical color change from colorless to dark orange appeared in each TPN solution over the 24-hr study period. Imipenem-cilastatin sodium is stable for 15 min in the TPN solutions studied; however, until the stability of the amino acids can be determined, the antibiotic should be administered through a separate line or Y-site while the TPN infusion is interrupted.

Effect of retrograde aminophylline administration on calcium and phosphate solubility in neonatal total parenteral nutrient solutions

The effect of retrograde administration of aminophylline injection on calcium and phosphate solubility in neonatal total parenteral nutrient (TPN) solutions was studied. Neonatal TPN solutions containing two amino acids solutions in three concentrations (Travasol 1% and 2% and TrophAmine 2%) were formulated. Calcium and phosphate salts were added to achieve calcium concentrations of 10, 15, 20, 25, 30, or 40 meq/L and phosphorus concentrations of 10, 15, 20, 25, 30, or 40 mmol/L. Samples were inspected visually after 18-24 hours; solutions free of precipitation were then infused through two parallel syringe-pump systems designed to simulate clinical conditions for TPN solution administration to a 1-kg neonate. To one system, a 7.5-mg aminophylline dose was added as a manual retrograde injection; sterile water for injection was added as a manual retrograde injection to the other system. The solutions were inspected throughout a one-hour infusion period for precipitate formation in the i.v. apparatus, and the pH of the effluents was determined. Concurrent aminophylline administration resulted in visible precipitate in all but a few of the solutions tested. The solution containing Travasol 2%, calcium 10 meq/L, and phosphorus 10 mmol/L remained clear, as did the solutions containing TrophAmine 2% and the following concentrations of calcium and phosphorus: calcium 10 meq/L and phosphorus 10, 15, or 20 mmol/L; calcium 15 meq/L and phosphorus 10 or 15 mmol/L; and calcium 20 meq/L and phosphorus 10 or 15 mmol/L. An average increase in pH of 0.63 unit was noted in all solutions.(ABSTRACT TRUNCATED AT 250 WORDS)

Stability of famotidine 20 and 40 mg/L and amino acids in total parenteral nutrient solutions

The stability of famotidine in total parenteral nutrient (TPN) solutions and the concentrations of amino acids in the presence of famotidine were determined. Two famotidine concentrations (20 mg/L and 40 mg/L) and two amino acid concentrations (20 g/L and 42.5 g/L) were studied under the following storage conditions: refrigerated for 24 hours and then kept at room temperature (20-22 degrees C) for 24 hours, at room temperature for 48 hours, or refrigerated for seven days. Control TPN solutions were studied under the same storage conditions. TPN solutions also contained dextrose 25%, electrolytes, trace elements, and vitamins. Famotidine concentration was determined at 0, 24, and 48 hours and at seven days by high-performance liquid chromatography. Amino acid concentration was determined in the TPN solutions containing 42.5 g/L of amino acids without famotidine and with famotidine 40 mg/L under both 48-hour storage conditions. At 24 hours, all solutions retained at least 95% of the initial famotidine concentration. Seven of the eight famotidine solutions retained more than 95% of the initial famotidine concentration at 48 hours. All samples refrigerated for seven days retained more than 95% of the initial famotidine concentration. The concentration of amino acids in TPN solutions containing 42.5 g/L of amino acids was not affected by the addition of famotidine 40 mg/L under either 48-hour storage condition. Famotidine in concentrations of 20 mg/L and 40 mg/L is stable under the studied 48-hour storage conditions in TPN solutions containing amino acid concentrations of either 20 g/L or 42.5 g/L.(ABSTRACT TRUNCATED AT 250 WORDS)

Long-term stability of famotidine 20 mg/L in a total parenteral nutrient solution

Long-term stability of famotidine 20 mg/L in a total parenteral nutrient solution

Stability of vancomycin hydrochloride in total parenteral nutrient solutions

Stability of vancomycin hydrochloride in total parenteral nutrient solutions

Spreadsheet program for neonatal and pediatric total parenteral nutrient solutions

Spreadsheet program for neonatal and pediatric total parenteral nutrient solutions

Potential incompatibility of insulin and octreotide in total parenteral nutrient solutions

Potential incompatibility of insulin and octreotide in total parenteral nutrient solutions

Sterility of total parenteral nutrient solutions stored at room temperature for seven days

The sterility of total parenteral nutrient (TPN) solutions stored at room temperature for up to seven days after preparation was studied. The study was conducted in two parts. In part 1, a positive control phase was conducted to validate that the filter set would capture bacteria or fungi in the TPN solutions. In part 2,300 unused TPN solutions were retrieved from patient-care areas within 24 hours of preparation. These solutions were randomized into three study groups of 24, 72, or 168 hours after preparation. Each TPN solution was filtered aseptically using an inline 0.22-micron filter. The filters were suspended in brain-heart infusion broth and incubated at 35 degrees C. Filters were visually evaluated for turbidity as an indicator of microbial contamination. Microbial growth was reported in 2 of 100 samples filtered 24 hours after preparation (group 1) and in 1 of 100 samples filtered 72 hours after preparation (group 2). No growth was detected in TPN solutions filtered 168 hours after preparation (group 3). Turbid samples were subcultured, and contaminants were identified as coagulase-negative Staphylococcus species and gram-positive bacilli in the group 1 samples and coagulase-negative Staphylococcus species in the group 2 samples. The difference in contamination rates among the three groups was not significant. TPN solutions may be stored after preparation at room temperature for an extended time (up to 168 hours) without increasing the risk to patient safety. However, at this institution, expiration dates are extended only to the time that supports practical recycling of standard TPN solutions (72 hours).

Temperature of refrigerated i.v. fluids and admixtures during infusion

The effects of infusion rate, drop size, and solution composition on the infusion temperature of i.v. fluids and admixtures that had been stored at refrigerated temperatures were determined. Polyvinyl chloride bags containing 5% dextrose injection, 0.9% sodium chloride injection, cefazolin 20 mg/mL in 5% dextrose injection, or total parenteral nutrient (TPN) solution were removed from the refrigerator after 12 hours and hung from i.v. poles. An administration set was attached to each bag, and the distal end of the administration tubing was placed in a beaker-funnel-flask apparatus that served as a collection vessel for effluent during simulated i.v. infusions. Thermo-couples were inserted into each i.v. bag and positioned under the distal end of each administration set to monitor the temperatures of the solution in the bag and of the effluent. 5% Dextrose injection and 0.9% sodium chloride injection were studied at two flow rates (125 and 60 mL/hr) using two different administration sets (60-drops/mL microdrip set and 15-drops/mL primary set); the cefazolin admixture and the TPN solution were studied at both flow rates using the primary set only. The temperatures at each probe were measured in triplicate at the start of each infusion and at 3, 6, 9, 12, 15, and 25 minutes during the infusion; each infusion was repeated three times. All of the solutions warmed significantly as they passed through the administration sets. Throughout all time intervals, the cefazolin admixtures had the smallest proximal-distal temperature increase, and the TPN solutions had the greatest increase.(ABSTRACT TRUNCATED AT 250 WORDS)

Use of standardized total parenteral nutrient solutions for premature neonates

Use of standardized total parenteral nutrient solutions for premature neonates

Calcium and Phosphate Solubility in Neonatal Parenteral Nutrient Solutions Containing Aminosyn-PF or TrophAmine

The maximum solubilities of calcium and phosphate in neonatal total parenteral nutrient (TPN) solutions compounded using Aminosyn-PF or TrophAmine amino acid injection were determined. Eight solutions were compounded from Sterile Water for Injection, USP, 50% dextrose injection, usual electrolytes and trace metals, and Aminosyn-PF 7% or TrophAmine 6% to obtain concentrations of amino acids 2.5% and dextrose 25% and amino acids 1% and dextrose 10%. Cysteine hydrochloride was added to half of the solutions at a concentration of 40 mg/g of protein. The pH of each solution was determined at various times during admixture preparation. The solutions were divided into 20-mL aliquots, and phosphate and calcium were added to each aliquot at concentrations of 2.5 to 50 meq/L of calcium and 5 to 50 mmol/L of phosphate. All solutions were inspected visually for signs of precipitation or crystallization after 18 hours of storage at room temperature and again after 30 minutes in a 37 +/- 1 degrees C water bath. Samples with no visible signs of precipitation were filtered, and the filter membrane was inspected under a microscope. Solubility curves were prepared by plotting the concentrations of calcium and phosphate at which either visual or microscopic precipitation occurred. Calcium and phosphate solubility was greater in the solutions with higher concentrations of amino acids and dextrose. In contrast to the results of some previous studies, no important differences in calcium and phosphate solubility were observed between Aminosyn-PF and TrophAmine in solutions containing amino acid concentrations of 2.5%, with or without added cysteine hydrochloride.(ABSTRACT TRUNCATED AT 250 WORDS)

Compatibility of Drugs with a Heparin-Containing Neonatal Total Parenteral Nutrient Solution

Compatibility of Drugs with a Heparin-Containing Neonatal Total Parenteral Nutrient Solution

Stability of penicillins in total parenteral nutrient solution

The stability of ticarcillin, mezlocillin, and piperacillin in total parenteral nutrient (TPN) solutions at concentrations commonly used in adults was determined. Each antibiotic was added separately to three different amino acids-dextrose TPN solutions in two concentrations: 10 and 20 mg/mL. Amino acids concentration ranged from 25 g/L to 50 g/L. Dextrose concentration ranged from 100 g/L to 350 g/L. Solutions were assayed for antibiotic concentration immediately after mixing (time 0) and at 4, 8, 24, and 48 hours by high-performance liquid chromatography. The effect of the added penicillins on the stability of amino acids and other TPN additives was not investigated. Mezlocillin and piperacillin 10 and 20 mg/mL exhibited stability in TPN solution at 24 hours. Ticarcillin was stable for 24 hours at a concentration of 10 mg/mL, but at 20 mg/mL it was unstable at all times tested. The three antibiotics demonstrated the same characteristic stability in all three TPN solutions, suggesting that the concentrations of dextrose and amino acids did not affect stability. Ticarcillin, mezlocillin, and piperacillin are stable for 24 hours in the TPN solutions studied.

Calcium and phosphate solubility in neonatal parenteral nutrient solutions containing Aminosyn PF

Factors affecting the solubility of calcium and phosphate in neonatal total parenteral nutrient (TPN) solutions containing a new amino acid formulation were studied. Six TPN solutions containing various concentrations of Aminosyn PF, an amino acid solution for infants and children, were prepared in 10% dextrose injection. Some of the solutions also contained cysteine hydrochloride 40 mg per gram of protein. Various concentrations of calcium gluconate and monobasic and dibasic potassium phosphate were added to 20-mL samples of the TPN solutions. A total of 27 samples of each TPN solution was prepared. Samples were visually inspected after 18 hours at 25 degrees C and again after 30 minutes in a water bath at 37 degrees C. Clear samples at this time were also examined microscopically. Solubility curves were prepared by plotting the concentrations at which either visual or microscopic precipitation occurred. Solubility curves for TPN formulations containing Aminosyn PF revealed a decrease in calcium solubility of 5 to 15 meq/L and a decrease in phosphate solubility of 5 to 15 mmol/L compared with previously published calcium-phosphate solubility curves for another similar amino acid solution, TrophAmine. Calcium and phosphate solubilities were also influenced by temperature and the time after solution preparation. In these TPN formulations containing Aminosyn PF as the amino acid source, the solubilities of calcium and phosphate were substantially less than reported in a previous study of solutions containing TrophAmine.

Providing 24-hour nutrient infusions to critically ill patients

The outcome of critically ill patients receiving total parenteral nutrient (TPN) therapy was evaluated, and the percentage of wasted TPN solutions administered as one-per-day (2- or 3-L) or multiple-per-day (750-mL or 1-L) infusions was determined. Between March 31 and June 1, 1984, all patients who were treated by the nutritional support service (NSS) and who met the study criteria were included in the study. The 24-hour nutrient content of each TPN solution was determined using a published method. Patient outcome was determined using TPN therapy data that were collected from the patients' medical charts and NSS records. To determine waste, all discarded TPN solutions were recorded. A total of 20 patients (10 men and 10 women) were included, representing 23.6% of the 76 patients who received TPN therapy during the study period. Study patients received 24-hour nutrient solutions for a mean of 16.4 +/- 12.9 days and required a mean of 3.9 +/- 4.6 days to reach sufficient metabolic stability to qualify for 24-hour infusions. During the study period, 56 (2.8 +/- 2.5 per patient) orders were changed. The percentage of wasted TPN solutions was low; 4.3% (17 of 1326) multiple-per-day and 1.7% (5 of 292) one-per-day solutions were wasted. Twenty-four-hour TPN solutions can be used successfully in critically ill patient populations.

Stability of vitamins in total parenteral nutrient solutions

Stability of vitamins in total parenteral nutrient solutions

Stability of tryptophan in total parenteral nutrient solutions

Stability of tryptophan in total parenteral nutrient solutions

Personnel costs and preparation time in a centralized intravenous admixture program

The amount of time and the cost of personnel time associated with the preparation of injectable products were determined. A time study consisting of 9041 observations during a seven-day period was conducted to determine the amount of time required of pharmacists and technicians for the preparation of total parenteral nutrient (TPN) solutions, large-volume injectables, antibiotic admixtures, antineoplastic admixtures, and investigational drugs. The established times were used to calculate relative value units for each product line and to determine the cost of pharmacist and technician time associated with the preparation of each product line. Preparation times ranged from 3.7 minutes for an antibiotic admixture to 49 minutes for a pediatric TPN solution. Total personnel costs ranged from $0.71 for an antibiotic admixture to $10.70 for a pediatric TPN solution. The calculated relative value units indicated that existing departmental time standards did not allow sufficient time for the preparation of some products. Establishing relative value units and calculating the cost of personnel time associated with the preparation of injectable products can be helpful for comparing the cost of purchasing ready-to-use products with the cost of preparing the same products.

Calcium and phosphate solubility in neonatal parenteral nutrient solutions containing TrophAmine

Factors affecting solubilities of calcium and phosphate in neonatal total parenteral nutrient (TPN) solutions containing a new amino acid formulation were examined. Twelve TPN solutions containing various concentrations of TrophAmine, an amino acid formulation specific for infants and young children, were prepared in 10% dextrose injection. Some of the solutions also contained cysteine hydrochloride 40 mg/g of protein and either sodium bicarbonate or hydrochloric acid (lipid emulsion buffer) to buffer the solution pH to simulate that produced by simultaneously administering lipid emulsion through the i.v. line. Calcium gluconate and monobasic and dibasic potassium phosphate were added to 20-mL samples of the TPN solutions to achieve calcium concentrations of 10, 20, 30, 40, or 50 meq/L with phosphate concentrations of either 10, 20, 30, or 40 mmol/L; a total of 20 samples of each TPN solution was prepared. Samples were inspected visually for precipitation or crystallization after 18 hours at 25 degrees C and again after 30 minutes in a water bath at 37 degrees C. Clear samples at this time were also examined microscopically for evidence of microcrystallization. Solubility curves were prepared by plotting graphically the concentrations at which either visual or microscopic precipitation occurred. Temperature, amino acid concentration, and the addition of cysteine hydrochloride and lipid emulsion buffer each influenced the solubilities of calcium and phosphate in the TPN solutions. The use of TrophAmine as the amino acid source allowed slightly greater concentrations of phosphate to be solubilized as compared with older amino acid formulations.(ABSTRACT TRUNCATED AT 250 WORDS)

Growth of bacteria and fungi in total nutrient admixtures

Total nutrient admixtures (TNAs) containing dextrose, amino acids, and fat emulsion were evaluated for their ability to support bacterial and fungal growth. The following solutions were tested: a standard adult total parenteral nutrient (TPN) solution with dextrose, amino acids, and electrolytes, a standard neonatal TPN solution with dextrose, amino acids, and electrolytes, a 10% fat emulsion, a 20% fat emulsion, a TNA with 40% of the total calories as fat, a TNA with 25% of the total calories as fat, a neonatal TNA with 25% of the total calories as fat, a control (fat emulsion was replaced with an equal amount of sterile water) for solution 5, and a control for solution 6. Serial dilutions of each solution were inoculated with 5 X 10(5) bacteria/mL or 5 X 10(3) fungi/mL, incubated, and visually rated on a scale of 0 (no growth) to 4 (maximal growth). Bacterial growth of Pseudomonas aeruginosa, Staphylococcus aureus, Staph. epidermidis, Streptococcus faecalis, and Group JK Corynebacterium was greater in the TNA solutions than in the control or standard TPN solutions. Escherichia coli, Candida tropicalis, and C. albicans grew in all solutions tested. Torulopsis glabrata grew better in solutions that did not contain fat emulsion. Growth characteristics did not differ significantly between the adult and neonatal (more dilute) solutions. The addition of fat emulsion to TPN solutions enhances the ability of these solutions to support bacterial growth; this possibility must be considered when evaluating patients for this type of total parenteral nutrition therapy.