Comparison of Visual and Turbidimetric Methods for Determining Short-term Compatibility of Intravenous Critical-care Drugs

Dasta, Joseph F.; Hale, Karen N.; Stauffer, Gene L.; Tschampel, Marva M.

doi:10.1093/ajhp/45.11.2361

Cited by 15 publications

(12 citation statements)

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“…Physical compatibility was confirmed using a previously defined visualization method 7 and is similar to previously published results. 5 Although this portion of the study was blinded, it was limited by 1 factor: an extended time course of 72 hours where observers were asked to identify incompatibilities based, in part, on color change.…”

Section: Discussionsupporting

confidence: 83%

Stability of Sodium Nitroprusside and Sodium Thiosulfate 1:10 Intravenous Admixture

et al. 2010

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Purpose Thiosulfate has been shown to reduce the risk of cyanide toxicity during nitroprusside administration. Admixtures containing both agents may provide a safe and effective alternative to more expensive agents used to reduce blood pressure in the critically ill patient. This study determined the physical and chemical stability of a 1:10 nitroprusside:thiosulfate admixture, stored up to 48 hours. The economic consequences of a shift toward using thiosulfate and nitroprusside, and away from higher cost alternatives, are considered. Methods Seven samples of 50 mg nitroprusside and 500 mg thiosulfate were prepared and stored away from light, at room temperature, and in a refrigerator prepared in D5W and NS. Each sample was analyzed via a novel high-performance liquid chromatographic (HPLC) method at time 0, 8, 24, and 48 hours. The method was tested and passed specifications for linearity, reproducibility, and accuracy. A visual inspection by 9 licensed pharmacists was used to demonstrate physical stability. A cost evaluation comparing nitroprusside and thiosulfate to alternative agents was completed. Results The concentration of both nitroprusside and thiosulfate remain greater than 95% of the initial concentration through 48 hours. Physical compatibility was confirmed in all samples tested through 72 hours. Conclusion The combination of nitroprusside and thiosulfate is chemically and physically stable as a single compounded dose for up to 48 hours when stored at room temperature and protected from light. The admixture represents an inexpensive option to other higher cost alternatives such as nicardipine or clevidipine.

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Section: Discussionsupporting

confidence: 83%

Stability of Sodium Nitroprusside and Sodium Thiosulfate 1:10 Intravenous Admixture

et al. 2010

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“…The absorbance light was scanned at 550 nm. The absorbance of more than 0.010 AU was considered as evidence of turbidity, providing a quantitative determination of incompatibility 14. An absorbance reading less than 0.010 AU was considered to be a noise level.…”

Section: Methodsmentioning

confidence: 99%

Physicochemical stability of etoposide diluted at range concentrations between 0.38 and 1.75 mg/mL in polyolefin bags

D’Huart¹,

Vigneron

Lider

et al. 2018

Eur J Hosp Pharm

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IntroductionAccording to the manufacturers, the diluted solution of etoposide should not exceed 0.4 mg/mL because precipitation may occur. For high doses or for patients requiring fluid restrictions, etoposide phosphate may be an option but shortages occurs frequently. The objective of this work was to study the stability of etoposide solutions between 0.38 and 1.75 mg/mL, diluted in 0.9% sodium chloride (0.9% NaCl) or 5% glucose (G5%) in polyolefin bags, stored at 25°C and between 2°C to 8°C, in a 61-day period. This study also observed the impact of an infusion pump on the physical and chemical stability of etoposide solutions.Materials and methodChemical stability was analysed at days 0, 9, 16, 21, 28 and 61 by high-performance liquid chromatography. Physical stability was evaluated by visual and subvisual inspection. The action of an infusion pump on solutions was evaluated to verify the impact of the mechanical pumping action on the etoposide solutions. This investigation was performed at day 61, at the end of the study.ResultsEtoposide solutions diluted at 0.38, 0.74 and 1.26 mg/mL in G5% and stored at 25°C were stable for 61 days and at 1.75 mg/mL for 28 days. In 0.9% NaCl, etoposide was less stable, with more precipitations observed. The action of an infusion pump has not caused any physical modifications.ConclusionStorage at 25°C and G5% as diluent are recommended for etoposide high concentration with 61-day stability up to a concentration of 1.26 mg/mL and 28-day stability up to a concentration of 1.75 mg/mL. As a precaution, the use of an administration set with an in-line micro-filter is nevertheless recommended. Storage at 2°C to 8°C and the use of 0.9% NaCl increase the risk of precipitation.

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“…A pH change of ≥1.0 was set a priori as compared with the time 0 or comparator solution as an indication of physical incompatibility based on several previously published studies. [6][7][8][9]…”

Section: Methodsmentioning

confidence: 99%

Physical Compatibility of Micafungin With Sodium Bicarbonate Hydration Fluids Commonly Used With High-Dose Methotrexate Chemotherapy

et al. 2017

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The purpose of this study was to determine the physical compatibility of micafungin with commonly used concentrations of sodium bicarbonate hydration fluids administered via a Y-site connected to a central venous catheter (Y-site/CVC). Micafungin sodium (evaluated concentration of 1.5 mg/mL) was combined in a 3:1 (vehicle:drug) ratio with the following commonly used hydration vehicles: 40 mEq/L sodium bicarbonate in 5% dextrose in water with ¼ normal saline (40SB-D5W-1/4NS), 75 mEq/L sodium bicarbonate in D5W (75SB-D5W), and 154 mEq/L sodium bicarbonate in D5W (154SB-D5W). A 3:1 ratio was used based on the flow rates (typically 125 mL/m/h for bicarbonate-containing vehicles and 50 mL/h for micafungin) of the corresponding solutions in a clinical setting. Visual observations recorded to determine physical compatibility included visual inspection against different backgrounds (unaided, black, and white). Other physical observations were as follows: odor, evolution of gas, pH, and turbidity immediately recorded after mixing and at specified time points up to 2 hours. Evaluations at each time point were compared against baseline observation values at Time 0. All combinations tested were found to be compatible up to 2 hours. Time points beyond 2 hours cannot be safely verified as compatible. Micafungin may be administered safely using a Y-site/CVC delivery system with all the vehicles tested in this study.

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Comparison of Visual and Turbidimetric Methods for Determining Short-term Compatibility of Intravenous Critical-care Drugs

Cited by 15 publications

References 0 publications

Stability of Sodium Nitroprusside and Sodium Thiosulfate 1:10 Intravenous Admixture

Stability of Sodium Nitroprusside and Sodium Thiosulfate 1:10 Intravenous Admixture

Physicochemical stability of etoposide diluted at range concentrations between 0.38 and 1.75 mg/mL in polyolefin bags

Physical Compatibility of Micafungin With Sodium Bicarbonate Hydration Fluids Commonly Used With High-Dose Methotrexate Chemotherapy

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