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Examination of sterility of total parenteral nutrition admixtures
ABSTRACTS NUTRITION ??H.Ciborowska,
FROM
THE
1OTH ANNUAL
MEETING
ur _n
M&et
HOSPITALORHOMEMADE
Dept of Dietetics, Medical Poland.
LIQUIDDIET FORTUBEFEEDING.
Professional
School, Krakow,
The example of hospital or home made liquid diet based on natural food ispresented. The diet contain 2000 kcal in 2000 ml ( lkcal/ 1 ml ) and is indicated for patients in whom oral feeding is not possible, but tube feeding will be indicated. The diet is nutritionally complete, easy to prepare and not expensive. It allows adequate and easy to provide enteral feeding
??J. Ptasihska, M. Ciszewska-Jedrasik, B.Marchlewska, A. Knyt * , M. Pertkiewicz * EXAMINATION OF STERILITY OF TOTAL PARENTERAL NUTRITION ADMIXTURES. Department of Applied Pharmacy and Clinic of Gastroenterological Surgery *, Warsaw Medical Academy, Poland. The main danger according to preparation of TPN admixtures is the risk of contamination these mixtures with following bacterial growth during storage and administration The aim of this study was to examine sterility of AI0 admixtures prepared at Laboratory of Parenteral Nutrition in Clinic of Gastroenterological Surgery Warsaw Medical Academy Admixtures ( Glucose 20 % and lb % , Aminoplasmal 15 % , Intralipid 20 % , Addiphos , MgS04 20 % , CaCl? 10 % , ZnClz : 1 mg Zn / 1 ml , Elkinton II ,KCI 15 % , Vitamin C, Bl , PP , B6 ) were prepared in Dimix 1330 bags ( Dif&plast ) , under aseptic conditions in laminar air - flow cabinet Examination of according to the Fifth Polish sterility was reahsed Pharmacopoeia FP V (direct inoculation in culture medium). Samples to be analysed were withdrawn immediately after preparation, aRer 24 h storage in room temperature ( 20 24 ’ C ) , after 24 h , 48 h, 14 days storage in temp. + 4 ’ C and 24 h in room temperature Bacterial or fungal growth was absent after incubation This is a proof of absence of any living micro-organisms in the mixtures These results proving that process of mixtures preparations is correct. This is possible to prepare and store mixtures for few days ( + 4 ’ C ) before administration without risk of loss of the microbiology stability
--
ItIE
POLISH
SOCIETY
OF PARENTERAL
AND
ENTERAL 607
??J. Pujdak * , M. Ciszewska - Jedrasik *, A. Knyt , K. Majewska, M. Pertkiewicz INFLUENCE OF AMINO ACIDS FOR STABILITY OF TOTAL PARENTERAL NUTRITION ADMIXTURES * Department of Applied Pharmacy and Clinic of Gastroenterological Surgery, Warsaw Medical Academy, Poland. Amino acids solutions have general stabilitating effect for the All-in-Oneadmixtures , but there are few infornrations about influences of their concentration and effect of the particular amino acids on stability of the mixtures The aim of this study was to examine the influence of different amino acids solutions for the stability of TPN admixtures used for Home Parenteral Nutrition. Compositions of admixtures used in hospital and at home are different ; there is higher concentration of all compounds in home admixtures what could be a reason of disturbance of their stability Two series of admixtures were made ( 6 of each ) with the same concentration of glucose , electrolytes , traces elements , vitamins, with 6 different solution of amino acids and Intralipid 20 % or 30 % Particle size distribution and pH measurement were made immediately after preparation and after 24 h or 48 h storage in temperature + 4 ’ C and 24 h in room temperature The stability of TPN admixtures depends on composition of the amino acids solution It seems , the most important is the low concentration of acidic amino acids (glutamic acid , asparaginic acid , cysteine). There were no radical difference between admixtures with Intralipid 20 % or 30 % stored for 34 h After longer storage mixtures made with Intralipid 30 % were more stable ??A. Rytel’.. M.Ciszewska-Jedrasik’, A.Knyt*. M.Petlkiewicz2. INSULIN & AMINOPHYLLIN AVAILABILITY PROMAMINOMIX ADMIXTURES. 1.Dcpt.of Applied Pharmacy. Medical Academy. Warsaw 2.Cbnic of Gastroenterologicd Surgery, Medical Academy. Warsaw. Aminophylline and/or insulin arc often added into AI0 nutrients admixtures. Known and constant delivery is essential for successful therapeutic effect. The aim was to determine aminophylline and insulin availability from Ammomix. a new convenient TPN system. Amino acids and glucose with electrolytes were mixed by breaking seal between the hvo chambers of Aminomix 1 IOOOmland Lipovenoes 20 % 250 ml was added using Preka Lipoflow system. Aminophylhnc 0,5g or 0,75g. Insulin Polfa or Organon 12 or 24 i.u. was added into 1250 ml complete admixture with fat and control admi.xture without fat via the injection port. pH, osmolarity, particle size distribution using Couher Counter, theophylline by UV spectrophotomeby after fat extraction for counting aminophyllinc concentration and insulin by RIA at 0,6,12 and 24 h after mixing were measured in triplicate. Aminophvlline availability at the catheter tip as % of initial dose and PSD. ( 0g / I,25 1 I 0,5g 0.25 I I 0,75g /1,25 1 Aruinophylliue I 100% I IO0% Aminouhvlhne. Oh 1 0 Y9.83% ] 99,76 % 99,83 % PSD < 2,s jr 100 % 100 % Amnwpl~yllme,24h 0 Y9,74% 9966 % Y9,76% YSD<2,5p lnsulin availability at the catheter tip as % of initial dose and PSD. Aminomix 1 Aminomix1 + Lipoveuoes c ( Inw11n Polfa ( !nsulin Organon ( +lusulin Polfa I ‘Tulle 1 12 i.u. 24 i.u ) 12 1.u. 24 i.u 1 12 1.” 24 1.u 1s ‘I 82 % 90 x 88% 90 x 46 % 411% 12h 70 % 80 % 75 % x1 “h 45 % 46 % 43 % 46 % 66% 80 X 64 % 76 % 24h + Lipoveuoes PSDa,Sp 99,83 % 99,740~ 99.81% 99,99% 99 09 % Oh 99,85 % 99,829/u 99,72% 99,99 % 90:Y9% 24 h There were not particleQ6 u. We concluded, aminophylline in presented concentrations is stable and 100 % available from Aminomix I + Lipovenoes without negative impact on the emulsion. Admixtures with insulin are also stable. Insulin availability depends on initial dose and without clinical decreases over time. However , this decrease is significance. Insulin is much better available from admixtures wrth fat.
FROM
THE
1OTH ANNUAL
MEETING
ur _n
M&et
HOSPITALORHOMEMADE
Dept of Dietetics, Medical Poland.
LIQUIDDIET FORTUBEFEEDING.
Professional
School, Krakow,
The example of hospital or home made liquid diet based on natural food ispresented. The diet contain 2000 kcal in 2000 ml ( lkcal/ 1 ml ) and is indicated for patients in whom oral feeding is not possible, but tube feeding will be indicated. The diet is nutritionally complete, easy to prepare and not expensive. It allows adequate and easy to provide enteral feeding
??J. Ptasihska, M. Ciszewska-Jedrasik, B.Marchlewska, A. Knyt * , M. Pertkiewicz * EXAMINATION OF STERILITY OF TOTAL PARENTERAL NUTRITION ADMIXTURES. Department of Applied Pharmacy and Clinic of Gastroenterological Surgery *, Warsaw Medical Academy, Poland. The main danger according to preparation of TPN admixtures is the risk of contamination these mixtures with following bacterial growth during storage and administration The aim of this study was to examine sterility of AI0 admixtures prepared at Laboratory of Parenteral Nutrition in Clinic of Gastroenterological Surgery Warsaw Medical Academy Admixtures ( Glucose 20 % and lb % , Aminoplasmal 15 % , Intralipid 20 % , Addiphos , MgS04 20 % , CaCl? 10 % , ZnClz : 1 mg Zn / 1 ml , Elkinton II ,KCI 15 % , Vitamin C, Bl , PP , B6 ) were prepared in Dimix 1330 bags ( Dif&plast ) , under aseptic conditions in laminar air - flow cabinet Examination of according to the Fifth Polish sterility was reahsed Pharmacopoeia FP V (direct inoculation in culture medium). Samples to be analysed were withdrawn immediately after preparation, aRer 24 h storage in room temperature ( 20 24 ’ C ) , after 24 h , 48 h, 14 days storage in temp. + 4 ’ C and 24 h in room temperature Bacterial or fungal growth was absent after incubation This is a proof of absence of any living micro-organisms in the mixtures These results proving that process of mixtures preparations is correct. This is possible to prepare and store mixtures for few days ( + 4 ’ C ) before administration without risk of loss of the microbiology stability
--
ItIE
POLISH
SOCIETY
OF PARENTERAL
AND
ENTERAL 607
??J. Pujdak * , M. Ciszewska - Jedrasik *, A. Knyt , K. Majewska, M. Pertkiewicz INFLUENCE OF AMINO ACIDS FOR STABILITY OF TOTAL PARENTERAL NUTRITION ADMIXTURES * Department of Applied Pharmacy and Clinic of Gastroenterological Surgery, Warsaw Medical Academy, Poland. Amino acids solutions have general stabilitating effect for the All-in-Oneadmixtures , but there are few infornrations about influences of their concentration and effect of the particular amino acids on stability of the mixtures The aim of this study was to examine the influence of different amino acids solutions for the stability of TPN admixtures used for Home Parenteral Nutrition. Compositions of admixtures used in hospital and at home are different ; there is higher concentration of all compounds in home admixtures what could be a reason of disturbance of their stability Two series of admixtures were made ( 6 of each ) with the same concentration of glucose , electrolytes , traces elements , vitamins, with 6 different solution of amino acids and Intralipid 20 % or 30 % Particle size distribution and pH measurement were made immediately after preparation and after 24 h or 48 h storage in temperature + 4 ’ C and 24 h in room temperature The stability of TPN admixtures depends on composition of the amino acids solution It seems , the most important is the low concentration of acidic amino acids (glutamic acid , asparaginic acid , cysteine). There were no radical difference between admixtures with Intralipid 20 % or 30 % stored for 34 h After longer storage mixtures made with Intralipid 30 % were more stable ??A. Rytel’.. M.Ciszewska-Jedrasik’, A.Knyt*. M.Petlkiewicz2. INSULIN & AMINOPHYLLIN AVAILABILITY PROMAMINOMIX ADMIXTURES. 1.Dcpt.of Applied Pharmacy. Medical Academy. Warsaw 2.Cbnic of Gastroenterologicd Surgery, Medical Academy. Warsaw. Aminophylline and/or insulin arc often added into AI0 nutrients admixtures. Known and constant delivery is essential for successful therapeutic effect. The aim was to determine aminophylline and insulin availability from Ammomix. a new convenient TPN system. Amino acids and glucose with electrolytes were mixed by breaking seal between the hvo chambers of Aminomix 1 IOOOmland Lipovenoes 20 % 250 ml was added using Preka Lipoflow system. Aminophylhnc 0,5g or 0,75g. Insulin Polfa or Organon 12 or 24 i.u. was added into 1250 ml complete admixture with fat and control admi.xture without fat via the injection port. pH, osmolarity, particle size distribution using Couher Counter, theophylline by UV spectrophotomeby after fat extraction for counting aminophyllinc concentration and insulin by RIA at 0,6,12 and 24 h after mixing were measured in triplicate. Aminophvlline availability at the catheter tip as % of initial dose and PSD. ( 0g / I,25 1 I 0,5g 0.25 I I 0,75g /1,25 1 Aruinophylliue I 100% I IO0% Aminouhvlhne. Oh 1 0 Y9.83% ] 99,76 % 99,83 % PSD < 2,s jr 100 % 100 % Amnwpl~yllme,24h 0 Y9,74% 9966 % Y9,76% YSD<2,5p lnsulin availability at the catheter tip as % of initial dose and PSD. Aminomix 1 Aminomix1 + Lipoveuoes c ( Inw11n Polfa ( !nsulin Organon ( +lusulin Polfa I ‘Tulle 1 12 i.u. 24 i.u ) 12 1.u. 24 i.u 1 12 1.” 24 1.u 1s ‘I 82 % 90 x 88% 90 x 46 % 411% 12h 70 % 80 % 75 % x1 “h 45 % 46 % 43 % 46 % 66% 80 X 64 % 76 % 24h + Lipoveuoes PSDa,Sp 99,83 % 99,740~ 99.81% 99,99% 99 09 % Oh 99,85 % 99,829/u 99,72% 99,99 % 90:Y9% 24 h There were not particleQ6 u. We concluded, aminophylline in presented concentrations is stable and 100 % available from Aminomix I + Lipovenoes without negative impact on the emulsion. Admixtures with insulin are also stable. Insulin availability depends on initial dose and without clinical decreases over time. However , this decrease is significance. Insulin is much better available from admixtures wrth fat.