The destabilization of parenteral feeding emulsions by heparin

Johnson, O.L.; Washington, C.; Davis, S.S.; Schaupp, K.

doi:10.1016/0378-5173(89)90317-7

Cited by 16 publications

(7 citation statements)

References 2 publications

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“…In some studies, heparin was added to the formula without any apparent disruption, as evidenced by a change in particle size. Heparin added to a TNA in the presence of calcium acts to immediately disrupt the phospholipid emulsifier by forming a cationic bridge 28 . There was no evidence of instability as indicated by MPS in the studies adding heparin to the formula 29 …”

Section: Particle Sizementioning

confidence: 91%

PFAT5 and the Evolution of Lipid Admixture Stability

Klang

2015

J Parenter Enteral Nutr

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PFAT5 is defined by United States Pharmacopeia Chapter 729 as follows: the "percentage of fat residing in globules larger than 5 µm (PFAT5) for a given lipid injectable emulsion [is] not to exceed 0.05%." The unstable aggregates are trapped in lungs, liver, and the reticuloendothelial system. Large particles will accumulate in pulmonary capillaries, which are between 4 and 9 µm in diameter. Over the years, there has been an evolution of methods to characterize and define intravenous fat emulsion (IVFE) stability when combined as a total nutrient admixture (TNA). Many studies have claimed IVFE stability measuring mean particle size, zeta potential, and visual checks. Interestingly, none of the studies that claimed the TNA as stable identified an unstable one through testing. This report reviews those parameters and shows they were not a valid measure of lipid stability. The PFAT5 parameter has emerged as the only validated measure of lipid stability. There are clinical consequences of using lipids that exceed the PFAT5 limit. This parameter is applicable to both manufactured and compounded lipid preparations. The clinician should be aware of the limitations of much of the literature concerning the lipid stability assessment. More stability studies are needed using PFAT5 to identify the actual limits of TNA compounding.

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Section: Particle Sizementioning

confidence: 91%

PFAT5 and the Evolution of Lipid Admixture Stability

Klang

2015

J Parenter Enteral Nutr

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“…113 Other drugs (eg, heparin) are not recommended for 3-in-1 PN admixtures because of influences on the integrity of the emulsion. [114][115][116] Therefore, including non-nutrient medication in PN admixtures is risky in the absence of appropriate evidence indicating compatibility and stability. 111 Specific criteria for evaluating compatibility and stability studies of medication in PN are well recognized and should be met.…”

Section: Questionmentioning

confidence: 99%

A.S.P.E.N. Clinical Guidelines

Boullata

Gilbert

Sacks

et al. 2014

J Parenter Enteral Nutr

253

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Background: Parenteral nutrition (PN) is a high-alert medication available for patient care within a complex clinical process. Beyond application of best practice recommendations to guide safe use and optimize clinical outcome, several issues are better addressed through evidence-based policies, procedures, and practices. This document provides evidence-based guidance for clinical practices involving PN prescribing, order review, and preparation. Method: A systematic review of the best available evidence was used by an expert work group to answer a series of questions about PN prescribing, order review, compounding, labeling, and dispensing. Concepts from the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) format were applied as appropriate. The specific clinical guideline recommendations were developed using consensus prior to review and approval by the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) Board of Directors. The following questions were addressed: (1) Does education of prescribers improve PN ordering? (2) What is the maximum safe osmolarity of PN admixtures intended for peripheral vein administration? (3) What are the appropriate calcium intake and calciumphosphate ratios in PN for optimal neonatal bone mineralization? (4) What are the clinical advantages or disadvantages of commercially available premade ("premixed") multichambered PN formulations compared with traditional/customized PN formulations? (5) What are the clinical (infection, catheter occlusion) advantages or disadvantages of 2-in-1 compared with 3-in-1 PN admixtures? (6) What macronutrient dosing limits are expected to provide for the most stable 3-in-1 admixtures? (7) What are the most appropriate recommendations for optimizing calcium (gluconate) and (Na-or K-) phosphate compatibility in PN admixtures? (8) What micronutrient contamination is present in parenteral stock solutions currently used to compound PN admixtures? (9) Is it safe to use the PN admixture as a vehicle for non-nutrient medication delivery? (10) Should heparin be included in the PN admixture to reduce the risk of central vein thrombosis? (11) What methods of repackaging intravenous fat emulsion (IVFE) into smaller patient-specific volumes are safe? (12) What beyond-use date should be used for (a) IVFE dispensed for separate infusion in the original container and (b) repackaged IVFE? (JPEN J Parenter Enteral Nutr. 2014;38:334-377)

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“…Other counter ions followed the order of Na + > Li + > K + > divalent ions. PLGA emulsions prepared with divalent heparin salts aggregated quickly and completely during the solvent evaporation process probably due to the bridging of the droplets in the presence of heparin and divalent ions, which also led to the aggregation of calcium-bound fat emulsions with the addition of heparin (35). The microspheres prepared using univalent heparin salts as the emulsifier were spherical and well-formed, as shown in Fig.…”

Section: Characterization Of Uni-and Di-valent Salts Of Heparinmentioning

confidence: 90%