Grouzmann Eric, Buclin Thierry, Biollaz Jérôme
Division of Clinical Pharmacology and Toxicology, Lausanne University Medical School, Lausanne, Switzerland.
Am J Health Syst Pharm. 2008 Feb 1;65(3):226-8. doi: 10.2146/ajhp070054.
A misleading blood tacrolimus concentration (BTC) value caused by the contamination of a central venous catheter previously used for tacrolimus administration is described.
A 59-year-old woman with severe chronic obstructive pulmonary disease successfully underwent double lung transplantation. In the intensive care unit, she received a continuous i.v. infusion of tacrolimus from days 1 to 5 after transplantation through the distal lumen of a polyurethane triple-lumen central venous catheter. The catheter lumen was flushed twice a day with 0.9% sodium chloride injection. The proximal lumen was used for blood sampling after being flushed; the first 10 mL of blood was discarded. BTCs determined in whole blood one, four, and five days after transplantation were within the therapeutic range of 5-15 ng/mL. On day five the patient was transferred to the thoracic surgery ward and was switched to oral tacrolimus 1.5 mg twice daily. The BTC on day 6 was unexpectedly high at 134.5 ng/mL. The patient's clinical status was normal, and no signs of tacrolimus toxicity were observed. On day 7, blood samples were drawn from a peripheral vein and simultaneously through the central venous catheter. Although the central venous catheter had not been exposed to tacrolimus during the preceding two days, it yielded blood with a BTC eight times higher than the BTC in blood from the peripheral vein (41.4 ng/mL versus 5.1 ng/mL).
The collection of blood from a central venous catheter lumen that had been used for tacrolimus administration resulted in a BTC about eight times higher than what was measured in peripheral blood.
描述因先前用于输注他克莫司的中心静脉导管污染导致的误导性血液他克莫司浓度（BTC）值。
一名患有严重慢性阻塞性肺疾病的59岁女性成功接受了双肺移植。在重症监护病房，她在移植后的第1天至第5天通过聚氨酯三腔中心静脉导管的远端腔持续静脉输注他克莫司。导管腔每天用0.9%氯化钠注射液冲洗两次。近端腔冲洗后用于采血；最初的10 mL血液被丢弃。移植后第1天、第4天和第5天测定的全血BTC在5 - 15 ng/mL的治疗范围内。第5天，患者转至胸外科病房，改为口服他克莫司，每日两次，每次1.5 mg。第6天的BTC意外地高达134.5 ng/mL。患者的临床状况正常，未观察到他克莫司毒性迹象。第7天，从外周静脉同时也通过中心静脉导管采集血样。尽管中心静脉导管在前两天未接触过他克莫司，但从该导管采集的血液中BTC比外周静脉血中的BTC高8倍（41.4 ng/mL对5.1 ng/mL）。
从曾用于输注他克莫司的中心静脉导管腔采集血液导致BTC比外周血中测得的值高约8倍。
