1. Department of Pharmacy, China-Japan Friendship Hospital, Beijing 100029, China; 2. Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China
Abstract:OBJECTIVE To investigate the adsorption of insulin in total nutrient admixture solutions(TNA) in three different material disposable parenteral nutrition infusion bags and provide the reference for compounding of parenteral nutrition and clinical nutrition support. METHODS TNA were compounded according to consensus for parenteral nutrition solutions compounding containing same prescriptions and same dose of insulin in different materialsinfusion bags including polyvinyl chloride(PVC) and ethylene-vinyl acetate copolymer(EVA) and triple chambered bag(TCB). Determination of concentrations of insulin by HPLC for 0, 2, 4, 6, 8, 10, 12, 14, 15 h with infusion speed 40 drops·min-1(2 mL·min-1). RESULTS The RESULTS of determination in 7 groups of TNA samples at different time points were between 69.5% to 102.8% of the oretical value. The insulin concentrations was low at the initial stage (0 and 2 h, mean difference: 2.4-8.0 IU·L-1). The concentrations of insulin in 4-15 h was no significant difference. There was a significant difference in different material bags:TCBvs EVA (mean difference:2.4 IU·L-1, P=0.012). PVC vs EVA(mean difference:1.6 IU·L-1, P=0.020).CONCLUSION The adsorption of insulin in EVA material bags is significantly different from that in TCB and PVC, the concentrations of insulin in TNA of different material bags was low in the initial stage (0 and 2 h). There is no significant difference in the concentrations of insulin at 4-15 h. When TNA is compounding in EVA, PVC and KABI nutritional bags, insulin can be used as a way to supplement for patients daily needs.
GOSMANOV A R, UMPIERREZ G E. Management of hyperglycemia during enteral and parenteral nutrition therapy[J] . Curr Diabetes Rep, 2013, 13(1):155-162.
[2]
LIN L Y, LIN H C, LEE P C, et al. Hyperglycaemia correlates with outcomes in patients receiving total parenteral nutrition[J] . Am J Med Sci, 2007, 333(5):261-265.
[3]
NEFF K, DONEGAN D, MACMAHON J, et al. Management of parenteral nutrition associatedhyper glycaemia: a comparison of subcutaneous and intravenous insulin regimen[J] . Ir Med J, 2014, 107(5):141-143.
[4]
LONG H, LIN Z C, WANG Y N, et al. Effect of different ways of insulin infusion in parenteral nutrition patients on activation andconcentration of insulin and blood glucose control:a prospective randomized comparison study[J] . Chin J Surg(中华外科杂志), 2009,47(4):286-288.
[5]
YE X H, ZHANG Z S, WANG X Y, et al. The effect of different infusion methods and time on insulin levels [J] .Parenter Enteral Nutr(肠外与肠内营养), 2005, 12(1):17-19.
[6]
MCCULLOCH A, BANSIYA V, WOODWARD J M. Addition of insulin to parenteral nutrition for control of hyperglycemia[J] . J Parent Ent Nut, 2018, 42(5):846-854.
[7]
ZHAO Y Y, SU F, WANG L J, et al. Study on concentration change of insulin injection during clinical transfusion [J] . Chin J Hosp Pharm(中国医院药学杂志), 2008, 28(19):1634-1638.
[8]
ZHAO B, LAO D H, SHANG Y G, et al. Congsensus for parenteral nutrition sulutionscompiunding[J] . Chin J Clin Nut(中华临床营养杂志), 2018, 26(3):72-84.
[9]
YANG H L, TIAN S J, LI C Y. Quantitative analysis of insulin in total parenteral nutrition bag in Taiwan[J] . J Food Drug Anal, 2016, 24(1):214-219.
[10]
FORCHIELLI M L L L, BONGIOVANNI F, PLATÉ L, et al. Insulin instability in parenteral nutrition admixtures [J] . J Parent Ent Nut,2018, 42(5):907-912.
[11]
CHRISTIANSON M A, SCHWARTZ M W, SUZUKI N. Determinants of insulin availability in parenteral nutrition solutions[J] . J Parenter Enteral Nutr, 2006, 30(1):6-9.
ICHIKAWA E, KIMURA M, MORI H, et al. Apparent increase of insulin peak area in HPLC analysis of a preparation consisting of a mixture of insulin and total parenteral nutrition[J] . Chem Pharm Bull, 2006, 54(8):1196-1199.
[14]
ZENG X J, ZHU Y, JIANG Z M, et al. Clinical practice of total parenteral nutrition[J] . Chin Pharm J(中国药学杂志), 1983,18(4):22-24.
[15]
NIEMIEC P W, VANDERVEEN T W. Compatibility considerations in parenteral nutrient solutions[J] . Am J Hosp Pharm, 1984, 41(5):893-911.
[16]
ZHAO Y X, YANG Z Y, XU N H, et al. Adsorption of insulin by PVC infusion bag [J] . Chin J Hosp Pharm(中国医院药学杂志), 2000, 20(10):634-635.
[17]
DOGLIETTO G B, BELLANTONE R, BOSSOLA M, et al. Insulin adsorption to three-liter ethylen vinyl acetate bags during 24-hour infusion[J] . Jpen J Parent Enteral Nutr, 1989, 13(5):539-541.
[18]
THOMPSON C D,VITAL-CARONA J, FAUSTINO E V. The effect of tubing dwell time on insulin adsorption during intravenous insulin infusions[J] . Diabetes Technol Ther, 2012, 14(10):912-916.
[19]
LING J, HU M, HAGERUP T, et al. Lispro insulin: adsorption and stability in selected intravenous devices[J] . Diabetes Educ, 1999, 25(5):237-245.
[20]
GOLDBERG A, KEDVES A, WALTER K, et al. "Waste not, want not":determining the optimal priming volume for intravenous insulin infusions[J] . Diabetes Technol Ther, 2006, 8(5):598-601.
[21]
ZAHIDN, TAYLOR K M, GILL H, et al. Adsorption of insulin onto infusion sets used in adult intensive care unit and neonatal care settings[J] . Diabetes Res Clin Pract,2008, 80(3):11-13.
[22]
MARCUARD S P, DUNHAM B, HOBBS A, et al. Availability of insulin from total parenteral nutrition solutions[J] . J Parent Ent Nut, 1990, 14(3):262-264.