Nezvalova-Henriksen Katerina, Nilsson Niklas, Østerberg Camilla Tomine, Staven Berge Vigdis, Tho Ingunn
Oslo Hospital Pharmacy, Rikshospitalet/Ullevål, Hospital Pharmacy Enterprise, South Eastern Norway, 0050 Oslo, Norway.
Department of Pharmacy, University of Oslo, 0316 Oslo, Norway.
Pharmaceutics. 2020 Jul 18;12(7):677. doi: 10.3390/pharmaceutics12070677.
Preterm neonates require parenteral nutrition (PN) in addition to intravenous drug therapy. Due to limited venous access, drugs are often co-administered with PN via the same lumen. If incompatible, precipitation and emulsion destabilization may occur with the consequent risk of embolism and hyper-immune reactions. Information on intravenous compatibility is scarce. Our aim was to analyse the compatibility of Numeta G13E with paracetamol, vancomycin and fentanyl because of the frequency of their use. A panel of methods was chosen to assess precipitation (sub-visual particle counting, turbidity measurement, Tyndall beam effect and pH measurement) and emulsion destabilization (mean droplet diameter measurement and sub-visual counting of oil droplets, followed by estimation of PFAT5 (percentage of fat residing in globules larger than 5 µm) and pH measurement). Samples in clinically relevant mixing ratios were tested immediately and after 4 h. All samples of drugs mixed with Numeta G13E were compared to unmixed controls. None of the tested drugs precipitated in contact with Numeta G13E, and we did not see any sign of emulsion destabilization when clinically relevant mixing ratios were applied. These results are reassuring. However, when contact time exceeds the established norm, caution in the form of filter utilisation and close inspection is advised.
除静脉药物治疗外，早产儿还需要肠外营养（PN）。由于静脉通路有限，药物通常通过同一管腔与PN联合给药。如果不相容，可能会发生沉淀和乳剂不稳定，从而有栓塞和超敏反应的风险。关于静脉相容性的信息很少。由于使用频率较高，我们的目的是分析Numeta G13E与对乙酰氨基酚、万古霉素和芬太尼的相容性。选择了一组方法来评估沉淀（亚视觉颗粒计数、浊度测量、廷德尔光束效应和pH测量）和乳剂不稳定（平均液滴直径测量和油滴亚视觉计数，随后估计PFAT5（大于5 µm的球粒中脂肪的百分比）和pH测量）。以临床相关混合比例的样品立即和4小时后进行测试。将所有与Numeta G13E混合的药物样品与未混合的对照进行比较。与Numeta G13E接触的受试药物均未沉淀，当采用临床相关混合比例时，我们未观察到任何乳剂不稳定的迹象。这些结果令人放心。然而，当接触时间超过既定标准时，建议使用过滤器并仔细检查。
