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Catheter related sepsis (CRS) in total parenteral nutrition (TPN): Subcutaneous infusion ports (SIP) VS percutaneous catheters (PC)
P.63
COMPATIBILITY OF CALCIUM AND PHOSPHOROUS IN TPN SOLUTIONS.
A comparative study between organic and inorganic phosphorous. 0 Rodell, M Linden, Pharmaceutical Research and Development, KabiVitrum AB, -Nutrition, Stockholm, Sweden The possibility of adding calcium and phosphorous in adequate amounts to parenteral nutrient solutions is limited due to precipitation of dibasic calcium phosphate and calciumphosphate (CaHPO /Ca PO] ). The solubility of calcium and phosphate in nutrient solutions is dapen aent 4i; o several factors such as pH of the solution, concentrations of calcium and phosphate,temperature, ion strength etc. However, one way to overcome these difficulties is to use organically bound phosphate, i.e. glycerophosphate or glucose-l-phosphate. In the present study we have compared the compatibility of hydrogen phosphate with glycerophosphate when added together with calcium to amino acid solutions. The results show that using sodium glycerophosphate up to 100 mmol/l phosphorous in combination with 40 mmol/l calcium, can be added without any precipitation occurring. In contrast when using sodium/potassium hydrogen phosphate the following amounts could be added:
< < < <
35 20 10 5.0
5 5.0 I 10 < 20 < 50
Nomograms for the addition of calcium and phosphorous, to amino acid solutions are presented, using the different phosphorous sources. Finally solubility curves for paediatric parenteral nutritional admixtures using sodium hydrogen phosphate or sodiun glycerophosphate are presented.
P.64 CATHETER RELATED SEPSIS (CRS) IN TOTAL PARENTERAL NUTRITION (TPN3) : SUBCUTANEOUS INFUSION PORTS (SIP) VS PERCUTANEOUS CATHETERS (PC) **Laboratoire de Bacteriologic fj.ynkpldn* - AM. Lacoste** - *Cllnique Saint-Jean
Faculte de Pharmacie - - Montpelller
- France
aim of thls study was to compare the frequency of CRS and the duration of use Of vascular accesses in long term TPN in patients receving TPN through a SIP or a PC. fXIYM!S : 58 patients were prospectively randomized into two groups : group I (n=26), TPN with a stllcone CP (Nutrlcath*) inserted in Internal Jugular Vein. Group II (n-32) TPN with a SIP : catheter in Internal Jugular Veln, chamber in a subcutaneous pocket on the chest. Duration of use of the vascular accesses was studied with the actuarial method over 10 months, Number of CRS was recensed in the two groups. Blood and catheter cultures were realized when a CRS was suspected. RWLTS : Median duration of TPN : 153 days in group I and 175 days in group II. 12 CP were removed in group I for CRS, 2 SIP were removed In group II 23 CRS were recensed In group I and 1 in group II. The occurence of a CRS was statistically related to, 1) immunodeficiency ; 2) concomitant sepsis elsewhere, 3) unexperienced nurse team. Actuacc to be removed in eight months rial probability of the first implanted vascular accede following insertion was higher in group I (ptO.05). The
: These results suggest that the use of SIP reduces the frequency TPN and allows a longer use of the same vascular access,
COlJCLUSlON
89
of CRS in
COMPATIBILITY OF CALCIUM AND PHOSPHOROUS IN TPN SOLUTIONS.
A comparative study between organic and inorganic phosphorous. 0 Rodell, M Linden, Pharmaceutical Research and Development, KabiVitrum AB, -Nutrition, Stockholm, Sweden The possibility of adding calcium and phosphorous in adequate amounts to parenteral nutrient solutions is limited due to precipitation of dibasic calcium phosphate and calciumphosphate (CaHPO /Ca PO] ). The solubility of calcium and phosphate in nutrient solutions is dapen aent 4i; o several factors such as pH of the solution, concentrations of calcium and phosphate,temperature, ion strength etc. However, one way to overcome these difficulties is to use organically bound phosphate, i.e. glycerophosphate or glucose-l-phosphate. In the present study we have compared the compatibility of hydrogen phosphate with glycerophosphate when added together with calcium to amino acid solutions. The results show that using sodium glycerophosphate up to 100 mmol/l phosphorous in combination with 40 mmol/l calcium, can be added without any precipitation occurring. In contrast when using sodium/potassium hydrogen phosphate the following amounts could be added:
< < < <
35 20 10 5.0
5 5.0 I 10 < 20 < 50
Nomograms for the addition of calcium and phosphorous, to amino acid solutions are presented, using the different phosphorous sources. Finally solubility curves for paediatric parenteral nutritional admixtures using sodium hydrogen phosphate or sodiun glycerophosphate are presented.
P.64 CATHETER RELATED SEPSIS (CRS) IN TOTAL PARENTERAL NUTRITION (TPN3) : SUBCUTANEOUS INFUSION PORTS (SIP) VS PERCUTANEOUS CATHETERS (PC) **Laboratoire de Bacteriologic fj.ynkpldn* - AM. Lacoste** - *Cllnique Saint-Jean
Faculte de Pharmacie - - Montpelller
- France
aim of thls study was to compare the frequency of CRS and the duration of use Of vascular accesses in long term TPN in patients receving TPN through a SIP or a PC. fXIYM!S : 58 patients were prospectively randomized into two groups : group I (n=26), TPN with a stllcone CP (Nutrlcath*) inserted in Internal Jugular Vein. Group II (n-32) TPN with a SIP : catheter in Internal Jugular Veln, chamber in a subcutaneous pocket on the chest. Duration of use of the vascular accesses was studied with the actuarial method over 10 months, Number of CRS was recensed in the two groups. Blood and catheter cultures were realized when a CRS was suspected. RWLTS : Median duration of TPN : 153 days in group I and 175 days in group II. 12 CP were removed in group I for CRS, 2 SIP were removed In group II 23 CRS were recensed In group I and 1 in group II. The occurence of a CRS was statistically related to, 1) immunodeficiency ; 2) concomitant sepsis elsewhere, 3) unexperienced nurse team. Actuacc to be removed in eight months rial probability of the first implanted vascular accede following insertion was higher in group I (ptO.05). The
: These results suggest that the use of SIP reduces the frequency TPN and allows a longer use of the same vascular access,
COlJCLUSlON
89
of CRS in