No abstract

Amikacin, gentamicin, tobramycin, vancomycin, and probably oral cyclosporine can be monitored accurately via central venous catheter. In contrast, IV cyclosporine should be monitored via peripheral blood.

Central venous catheters are being used with increasing frequency to administer drugs, and as a result, catheter obstruction caused by precipitation of poorly soluble fluid components has become a common problem. We report our first experience using 0.1 N hydrochloric acid to restore patency to central venous catheters obstructed from insolubility-induced precipitation. Precipitation was caused by drug as well as calcium and phosphorus incompatibilities. The initial use of urokinase in two cases was unsuccessful in restoring catheter patency. In all four cases, the instillation of 0.2-1.0 ml of HCl cleared the catheters. Catheter patency usually was gained immediately. No side effects were noted. Our experience supports preliminary data (JPEN 9 (suppl):255, 1985) which suggest that 0.1 N HCl is effective in clearing insolubility-induced precipitation in central venous catheters.

The Food and Drug Administration has received 51 reports of cases in the United States in which chemical peritonitis was associated with the intraperitoneal administration of sterile vancomycin hydrochloride, USP intravenous. The clinical presentation of the cases ranged from mild (cloudy dialysate alone) to more severe (severe abdominal pain and fever). The temporal circumstances suggest that intraperitoneal vancomycin may be associated with chemical peritonitis. A positive rechallenge was reported in 9 cases. The underlying mechanism responsible for this adverse reaction has not yet been identified. Several adverse reaction reports have been submitted to the Food and Drug Administration (FDA) concerning the development of chemical peritonitis in continuous ambulatory peritoneal dialysis (CAPD) patients following the intraperitoneal administration of sterile vancomycin hydrochloride, USP intravenous. The reactions reported ranged from mild (cloudy dialysate alone) to more severe (severe abdominal pain and fever). Although the majority of reactions were self-limited, some resulted in hospitalization and/or a prolongation of antibiotic therapy. Based upon these reaction reports, the FDA issued a Safety Alert Letter in May 1990 to all known dialysis centers in the United States (1). The purpose of this article is to provide additional clinical and laboratory data on the cases cited in the Safety Alert Letter.