Inamrinone lactate (amrinone). Abbott. 44-341-DK. 0.5. 1. 2.5. 1/5. Isoproterenol HCl. Abbott. 33-048-DK. 0.02. 7. 2.0 none. Leucovorin calcium. Gensia. P8J301.
Intravenous Therapy
Adequacy of a New Chlorhexidine-Bearing Polyurethane Central Venous Catheter for Administration of 82 Selected Parenteral Drugs Quanyun A Xu, Yanping Zhang, Lawrence A Trissel, and Doward L Gilbert
OBJECTIVE:
To screen 82 commonly used parenteral medications for compatibility with a new chlorhexidine-bearing central venous catheter, the ARROWg+ard Blue Plus. Evaluations were performed for completeness of drug delivery and impact, if any, of the drugs on the amount of chlorhexidine removed from the internal lumens.
DESIGN: Drug solutions were prepared in dextrose 5% injection or NaCl 0.9% at common concentrations. Three 10-mL aliquots of each drug solution were delivered over 10 minutes, one aliquot through each lumen of the triple-lumen catheter. The initial drug concentrations of the admixtures and the effluent samples were analyzed by HPLC for chlorhexidine content and for the amount of drug delivered relative to its initial concentration. RESULTS: The delivery of the infusion solutions alone through sample catheters resulted in no more than trace amounts of chlorhexidine in the solution. Background amounts ranged from 0.998 over the concentration range of 2.5–25 µg/mL. For a nominal chlorhexidine concentration of 9 µg/mL, the mean ± SD precision of the assay, determined from 10 replicate injections, was 9.0 ± 0.3 µg/mL. Precision, expressed as percent relative standard deviation, was 3.8%.
a
Part #APX-7334-A, lot 1001, ARROW International, Reading, PA. Pliva d.d. Zagreb, lot 3476074, Pliva d.d., Zagreb, Croatia. Baxter Healthcare, Deerfield, IL, lot PS063958. d Baxter Healthcare, lot PS075952. e Model 600E, Waters Chromatography, Milford, MA. f Model 490E, Waters Chromatography. g WSIP Model 712, Waters Chromatography. h Millennium 2010 Chromatography Manager, Waters Chromatography. b c
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The Annals of Pharmacotherapy
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In preliminary work, it was determined that the greatest chlorhexidine content is present in the first 10 mL of solution that initially passes through a particular lumen of the catheter; the concentration declines thereafter. Consequently, we elected to evaluate the first 10-mL aliquot of solution for each drug sample through new catheter lumens to assess the maximum potential, if any for chlorhexidine interaction. The 82 drugs screened for compatibility with the catheters and their concentrations are listed in Table 1. The drugs were prepared in 50-mL polyvinyl chloride bags of dextrose 5% injection except for ampicillin sodium, ampicillin sodium–sulbactam sodium, imipenem/cilastatin, and meropenem, which were prepared in NaCl 0.9% injection. All manipulations were performed in a Class 100 biological safety cabinet. After compounding of the test drug solutions, a 10-mL aliquot was removed from the admixture bag for establishing the normal drug chromatogram and determination of the initial drug concentration. Each bag was then attached to one lumen of a new triple-lumen catheter, and 10 mL of the drug solution was delivered through the catheter over 10 minutes. This was repeated through each of the other two lumens of the catheter. The effluent was collected independently from each lumen in glass screw-cap vials. The effluent samples were used for comparison with the initial solution for drug concentration and chlorhexidine content. To serve as control solutions, 10-mL aliquots of dextrose 5% injection and NaCl 0.9% injection were delivered in triplicate through new catheters. Incompatibility was defined as delivery of
