Information Center for Infusion Therapy and Product, Otsuka Pharmaceutical Factory, Inc., 115 Kuguhara, Tateiwa, Muya-cho, Naruto, Tokushima 772-8601, Japan.
Department of Nursing, Niigata University Graduate School of Health Sciences, 2-746 Asahimachi, Niigata, Niigata 951-8518, Japan.
Clin Nutr ESPEN. 2021 Feb;41:287-292. doi: 10.1016/j.clnesp.2020.11.019. Epub 2020 Dec 18.
BACKGROUND & AIMS: There has been no clear evidence regarding the appropriate method of flushing catheters and totally implantable venous access devices (TIVADs) after lipid emulsion (LE) administration. Therefore, the aim of the study was to identify appropriate methods of flushing to minimize residual LE when using TIVADs to ensure the safety of long-term total parenteral nutrition (TPN) and home parenteral nutrition (HPN).
A soybean oil LE containing indocyanine green (ICG) was administered from the injection site of the primary infusion set for flowing TPN, and LE dynamics were evaluated by a fluorescence imaging system. TIVADs were connected to the end of the infusion sets. After LE administration, the tubes and chambers were flushed from the injection site using saline at various speeds (20, 40, 60 mL/min), with and without pulsation. The washout effect of TPN solution after LE administration followed by flushing was examined, as was the washout effect of size differences in the infusion sets.
When the LE was flushed with 20 mL of saline immediately after administering the LE using a standard infusion set (inner diameter 2.5 mm), the LE still remained in the tubes and chambers under any flushing condition. Flushing the LE from the injection site with 10 mL of saline and then flowing >240 mL of TPN solution were effective for minimizing residual LE inside the tubes and chambers. When using an infusion set with a small inner diameter (1.0 mm), the LE inside the tubes and chambers was almost discharged with ≥20 mL of saline immediately after administering the LE. In all settings, flushing with/without pulsation did not affect LE washout efficacy.
Flushing immediately with saline ≥10 mL and then flowing >240 mL of primary PN solution after soybean oil LE administration using the standard infusion set or flushing with 20 mL saline immediately after administering the soybean oil LE using the infusion set with a small inner diameter are effective for minimizing the residual LE in the catheter and TIVAD, ensuring the safety of long-term TPN and HPN.
在给予脂肪乳（LE）后，对于导管和完全植入式静脉输液港（TIVAD）的冲洗方法，尚无明确证据。因此，本研究旨在确定适当的冲洗方法，以最大限度地减少 LE 残留，从而确保长期全肠外营养（TPN）和家庭肠外营养（HPN）的安全。
在 TPN 输注的初始输注套件的注射部位给予含有吲哚菁绿（ICG）的大豆油 LE，并使用荧光成像系统评估 LE 动力学。将 TIVAD 连接到输注套件的末端。给予 LE 后，使用生理盐水以不同速度（20、40、60 mL/min）从注射部位冲洗管路和腔室，有或无脉冲。检查 LE 给药后 TPN 溶液的冲洗效果，以及输注套件大小差异的冲洗效果。
使用标准输注套件（内径 2.5 mm）立即在给予 LE 后用 20 mL 生理盐水冲洗时，在任何冲洗条件下，LE 仍留在管路和腔室内。从注射部位用 10 mL 生理盐水冲洗后，再流动>240 mL TPN 溶液，可有效减少管路和腔室内的 LE 残留。使用内径较小的输注套件（1.0 mm）时，立即给予 LE 后，管路和腔室内的 LE 几乎可以用≥20 mL 生理盐水排出。在所有设置中，有无脉冲冲洗均不影响 LE 冲洗效果。
使用标准输注套件在给予大豆油 LE 后立即用生理盐水≥10 mL 冲洗，然后流动>240 mL 初始 PN 溶液，或使用内径较小的输注套件在给予大豆油 LE 后立即用 20 mL 生理盐水冲洗，可有效减少导管和 TIVAD 中的 LE 残留，确保长期 TPN 和 HPN 的安全。
