Background Drug incompatibilities, such as precipitates, may contribute to the clinical deterioration of paediatric patients (sepsis), especially when infusing vancomycin and piperacillin (VAN/PIP). Drug concentration and infusion sets affect the overall particulate contamination of paediatric infusion protocols. Using multilumen infusion sets could prevent these incompatibilities.
Purpose To define and assess a new way to infuse VAN/PIP during leukaemia treatment in paediatric patients, without any visible precipitate.
Material and methods Two infusion sets were studied, which differed in design and drug dead-space volume (V): 1) a standard single lumen set with 2 four-port manifolds with extension lines (ref RPB4320, Cair LGL, France; V ∼ 12 mL) and 2) a 5-lumen infusion set (ML-5) (Edelvaiss-Multiline, Doran International, France; V ∼ 1 mL). Different vancomycin concentrations (VANc) were tested to infuse VAN/PIP simultaneously without any precipitate (optimised multidrug protocol). A dynamic particle count test was performed (N = 5) over 24 h to evaluate the overall particulate contamination of our standard (VANc = 42 mg/mL) and optimised (VANc = 4 mg/mL) protocols, using both standard and ML-5. We performed a t-test.
Results No visible particles were detected on reducing VANc (4 mg/mL) instead of the standard dose (42 mg/mL). For the optimised multidrug protocol, using the ML-5 reduced the overall particulate contamination by 68%, compared to the standard infusion set (716,349 ± 89,322 vs. 251,980 ± 49,429; p = 0.002). The number of large particle sizes was significantly reduced when using the ML-5 ∼ 60% (p = 0.027) and 90% (p = 0.009) for particle sizes ≥10 and 25 µm, respectively.
Conclusion This study demonstrated the large number of particles administered during parenteral multidrug infusion. This can be minimised through the choice of the drug concentration and/or the type of infusion set. Although this kind of contamination is invisible, further studies are required to evaluate its adverse clinical impact.
References and/or acknowledgements No conflict of interest.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.