Trissel L A, Gilbert D L, Martinez J F, Baker M B, Walter W V, Mirtallo J M
Division of Pharmacy, University of Texas, M.D. Anderson Cancer Center, Houston 77030, USA.
JPEN J Parenter Enteral Nutr. 1999 Mar-Apr;23(2):67-74. doi: 10.1177/014860719902300267.
The absence of drug compatibility information with 3-in-1 parenteral nutrition admixtures has been problematic. The purpose of this project was to evaluate the physical compatibility of 106 selected drugs during simulated Y-site injection into nine different 3-in-1 parenteral nutrition admixture formulations.
Four-milliliter samples of each of the representative 3-in-1 parenteral nutrition admixture formulations were combined in a 1:1 ratio with 4-mL samples of each of 106 drugs, including supportive care drugs, anti-infectives, and antineoplastic drugs. Six replicate samples of each combination were prepared. Two samples were evaluated initially after mixing, two more after 1 hour, and the last two after 4 hours at 23 degrees C. At each test interval, the samples were subjected to centrifugation, causing the fat to rise to the top. The top fat layer and most of the aqueous phase were removed, and the remaining liquid was diluted with about 7 mL of particle-free, high-performance liquid chromatography-grade water to facilitate observation of any particulates that might have formed. Visual examinations were performed in normal diffuse fluorescent laboratory light and under high-intensity, monodirectional light.
Most of the drugs tested were physically compatible with the 3-in-1 parenteral nutrition admixtures for 4 hours at 23 degrees C. However, 23 drugs exhibited various incompatibilities with one or more of the parenteral nutrition admixtures. Six drugs resulted in the formation of precipitate with some or all of the admixtures. Seventeen drugs caused disruption of the emulsion, usually with oiling out.
Most of the test drugs were physically compatible with the nine representative 3-in-1 parenteral nutrition admixtures. However, the 23 drugs that resulted in incompatibilities should not be administered simultaneously with the incompatible parenteral nutrition admixtures via a Y injection site.
缺乏三合一肠外营养混合液的药物配伍信息一直是个问题。本项目的目的是评估106种选定药物在模拟Y型接口注射入九种不同的三合一肠外营养混合液配方过程中的物理相容性。
将每种代表性的三合一肠外营养混合液配方的4毫升样品与106种药物（包括支持性护理药物、抗感染药物和抗肿瘤药物）中的每种药物的4毫升样品按1:1的比例混合。每种组合制备六个重复样品。在23摄氏度下，每种组合的两个样品在混合后立即进行评估，另外两个在1小时后评估，最后两个在4小时后评估。在每个测试间隔，对样品进行离心，使脂肪升至顶部。去除顶部脂肪层和大部分水相，并用约7毫升无颗粒的高效液相色谱级水稀释剩余液体，以便观察可能形成的任何颗粒。在正常的漫射荧光实验室光线下和高强度单向光线下进行目视检查。
大多数测试药物在23摄氏度下与三合一肠外营养混合液在4小时内物理相容。然而，23种药物与一种或多种肠外营养混合液表现出各种不相容性。六种药物与部分或全部混合液形成沉淀。十七种药物导致乳剂破坏，通常出现油相分离。
大多数测试药物与九种代表性的三合一肠外营养混合液在物理上相容。然而，导致不相容的23种药物不应通过Y型注射部位与不相容的肠外营养混合液同时给药。
