Evaluation of the amount of residual lipid emulsion in chambers of flushed totally implantable venous access devices using fluorescence imaging

Abstract

The aim of the present study was to use a quantitative fluorescence imaging technique to evaluate the invisible amount of residual lipid emulsion in port chambers flushed with various fundamental protocols. Chambers were filled with lipid emulsion containing indocyanine green and then flushed with 5–70 mL of normal saline. Chambers were flushed at various speeds (15–60 mL/min), with a time interval of 1 or 3 s between boluses, and with varying directions of flow. The slower the flushing speed, the more lipid emulsion that remained. Pulsatile flushing with either time interval did not decrease the residual amounts, and the areas well-cleansed after flushing were oriented to the bevel-opening direction. These findings suggest that to reduce the residual amount of lipid emulsion poured in a chamber, fast and furious flushing under continuous as opposed to pulsatile flushing is of paramount importance.

How to perform appropriate flushing after lipid emulsion administration using totally implantable venous access devices in long-term total parenteral nutrition and home parenteral nutrition

“…This idea supports the result that the LE is effectively discharged when flushed at a high speed of 40 mL/min or more. This result supports the present clinical practice and previous research showing that flushing with 10e20 mL of normal saline using a CV catheter is recommended, but the flushing speed should exceed 40 mL/min using a primary infusion set with a small inner diameter [12,19].…”

“…2 injection (EP) (1000 mL, Otsuka Pharmaceutical Factory, Inc., Tokushima, Japan), was used in the primary infusion set. For tracing soybean oil LE dynamics, indocyanine green (ICG) was used because ICG is easy to uniformly combine with emulsified lipid, and it also has fluorescent characteristics that are useful for later detection, as shown in our past report [12]. The soybean oil LE and ICG mixture, which consisted of Intralipos injection 20% (soybean oil 200 mg/mL, Otsuka Pharmaceutical Factory, Inc., Tokushima, Japan) 100 mL with dissolved ICG (Diagnogreen for injection 25 mg, Daiichi Sankyo Company, Ltd., Tokyo, Japan), was also used as an LE in the present study.…”

“…Measurement of residual LE using fluorescence imaging has been described previously [12]. In brief, the distribution of ICG fluorescence in the flushed tubes and chambers was monitored using the IVIS Spectrum live imaging system (PerkinElmer, Boston, MA, USA) with excitation and emission at 745 and 840 nm, respectively.…”

“…As far as we know, there is as yet no clear evidence regarding the appropriate method for soybean oil LE flushing of the CV route and TIVAD. Therefore, we have previously reported briefly on the flushing method after separate administration of the LE [12]. This paper presents the complete results of our investigation of flushing to minimize residual LE when using a TIVAD to ensure the safety of long-term TPN and HPN.…”

Comparing the Effects of Pulsatile and Continuous Flushing on Time and Type of Peripheral Intravenous Catheters Patency: A Randomized Clinical Trial

“…Unfortunately, there is no standard protocol or sufficient clinical evidence related to flushing and there is no consensus among the researchers regarding the instructions used to maintain catheter patency. 11,12 The existence of strong clinical evidence could have facilitated decision making for selecting the best technique, and subsequently increased PICs longevity. Nursing knowledge has always sought to improve patient care quality, and flushing techniques may reduce catheter insertion frequency and result in less pain and anxiety in patients.…”