Physical compatibility of 4% sodium citrate with selected antimicrobial agents

Dotson, Bryan; Lynn, Scarlett; Savakis, Katherine; Churchwell, Mariann D.

doi:10.2146/ajhp090505

Cited by 22 publications

(27 citation statements)

References 7 publications

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“…Tobramycin 2.4 mg/mL and TSC 40 mg/mL display visual compatibility at room temperature and at 37 °C for 48 hours. 7 Other studies have found tobramycin 5 mg/mL plus heparin sodium 5000 units/mL or TPA 1 mg/mL to be compatible for 12 hours at room temperature. [30][31][32] Although limited, compatibility data on tobramycin with TSC or TPA support the possibility of using those agents in combination for patients intolerant of other agents or patients requiring TPA for CVC patency.…”

Section: Antibacterialsmentioning

confidence: 96%

“…26 Gentamicin 2.5 mg/mL with TSC 40 mg/mL remains stable, with no change in gentamicin concentration, for at least 112 days at room temperature. 5,7,8 Solutions of gentamicin 3 mg/mL and daptomycin 1 mg/mL with or without TSC 28 mg/ mL maintained more than 90% of the original drug concentrations for 48 hours. 9 Gentamicin 5 mg/mL has also been studied with EDTA 30 mg/mL, and visual compatibility for at least 72 hours at 25 or 37 °C was demonstrated.…”

Section: Antibacterialsmentioning

confidence: 99%

“…1 Heparin is the most commonly used anticoagulant additive in ALT, but other compounds, including trisodium citrate (TSC) and ethylenediaminetetraacetic acid (EDTA), which work synergistically with most antiinfectives, as well as thrombolytics, have been studied. [5][6][7][8][9][10][11] Because of the increase in ALT utilization in both inpatient and outpatient settings and the continuing emergence of novel lock solutions, it is imperative that concise and validated stability and compatibility data are available to practitioners. This review details the available stability and compatibility data from evaluations of antimicrobial lock solutions used in combination with anticoagulants or other additives and provides recommendations for clinical application.…”

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confidence: 99%

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Stability and compatibility of antimicrobial lock solutions

Bookstaver

Rokas

Norris³

et al. 2013

American Journal of Health-System Pharmacy

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Section: Antibacterialsmentioning

confidence: 96%

Section: Antibacterialsmentioning

confidence: 99%

mentioning

confidence: 99%

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Stability and compatibility of antimicrobial lock solutions

Bookstaver

Rokas

Norris³

et al. 2013

American Journal of Health-System Pharmacy

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“…The antibiotic lock solution was prepared by either the inpatient pharmacy or an affiliated home infusion pharmacy under sterile conditions (22,23). The locking solution was instilled in a volume sufficient to fill each catheter lumen at the end of dialysis and aspirated at the next dialysis session before connection.…”

Section: Catheter Locking Solutionsmentioning

confidence: 99%

Comparative Effectiveness of Two Catheter Locking Solutions to Reduce Catheter-Related Bloodstream Infection in Hemodialysis Patients

Moore

Besarab

Ajluni

et al. 2014

Clinical Journal of the American Society of Nephrology

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Background and objectives Infection is the second leading cause of death in hemodialysis patients. Catheterrelated bloodstream infection and infection-related mortality have not improved in this population over the past two decades. This study evaluated the impact of a prophylactic antibiotic lock solution on the incidence of catheter-related bloodstream infection and mortality.Design, setting, participants, & measurements This prospective, multicenter, observational cohort study compared the effectiveness of two catheter locking solutions (gentamicin/citrate versus heparin) in 555 hemodialysis patients dialyzing with a tunneled cuffed catheter between 2008 and 2011. The groups were not mutually exclusive. Rates of catheter-related bloodstream infection and mortality hazards were compared between groups.Results The study population (n=555 and 1350 catheters) had a median age of 62 years (interquartile range=41-83 years), with 50% men and 71% black. There were 427 patients evaluable in the heparin period (84,326 days) and 322 patients evaluable in the antibiotic lock period (71,192 days). Catheter-related bloodstream infection in the antibiotic lock period (0.45/1000 catheter days) was 73% lower than the heparin period (1.68/1000 catheter days; P=0.001). Antibiotic lock use was associated with a decreased risk of catheter-related bloodstream infection compared with heparin (risk ratio, 0.23; 95% confidence interval, 0.13 to 0.38 after multivariate adjustment). Cox proportional hazards modeling found that antibiotic lock was associated with a reduction in mortality (hazard ratio, 0.36; 95% confidence interval, 0.22 to 0.58 in unadjusted analyses; hazard ratio, 0.32; 95% confidence interval, 0.14 to 0.75 after multivariate adjustment). The rate of gentamicin-resistant organisms decreased (0.40/1000 person-years to 0.22/1000 person-years) in the antibiotic lock period (P=0.01). ConclusionsThe results of this study show that the use of a prophylactic, gentamicin/citrate lock was associated with a substantial reduction in catheter-related bloodstream infection and is the first to report a survival advantage of antibiotic lock in a population at high risk of infection-related morbidity and mortality.

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“…Based on previously published literature, incompatibility was defined as the presence of haze, particulate formation, gas evolution, color change, or precipitation on visual inspection, ≥1 pH unit change over the 4-hour course of the experiment, or any absorbance of >0.01 A. [7][8][9][10][11][23][24][25] To simulate actual Y-site infusion, we sought to replicate the infusion process conducted by nursing personnel in the clinical setting. All actual Y-site infusions were completed in duplicate to enhance the validity and accuracy of this study.…”

Section: Methodsmentioning

confidence: 99%

Y-site Incompatibility between Premix Concentrations of Vancomycin and Piperacillin-Tazobactam: Do Current Compatibility Testing Methodologies Tell the Whole Story?

et al. 2017

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Background:Published literature has demonstrated commercially available premix vancomycin (5 mg/mL) and piperacillin-tazobactam (67.5 mg/mL) as physically compatible via simulated Y-site methodology. Compatibility via actual Y-site infusion has yet to be established. Objective: To assess and compare the compatibility of commercially available premix concentrations of vancomycin and piperacillin-tazobactam via simulated and actual Y-site evaluation. Methods: Vancomycin and piperacillin-tazobactam were tested using simulated and actual Y-site infusion methodologies. Simulated Y-site compatibility was performed using previously published methods via visual inspection, turbidity evaluation, and pH evaluation. Evaluation occurred immediately, 60 minutes, 120 minutes, and 240 minutes following mixing for each mixture and control. Mixtures were considered physically incompatible if there was visual evidence of precipitation or haze, an absorbance value was greater than 0.01 A, or an absolute change of 1.0 pH unit occurred. Actual Y-site infusion was simulated to mirror antibiotic infusion in the clinical setting by nursing personnel using smart pumps and intravenous tubing. Results: No evidence of physical incompatibility was observed during simulated Y-site testing via visual inspection, turbidity assessment, and pH evaluation. Conversely, physical incompatibility was observed to the unaided eye within 2 minutes during actual Y-site infusion. Conclusions: Despite observed compatibility between vancomycin and piperacillin-tazobactam via simulated Y-site testing, visual evidence of physical incompatibility was observed during actual Y-site infusion. This poses a potential compromise to patient safety if these antibiotics are administered simultaneously in the clinical setting. Actual Y-site testing should be performed prior to clinical adoption of compatibility studies that are based solely on simulated methodologies.Key Words-incompatibility, piperacillin-tazobactam, premix antibiotics, vancomycin, Y-site compatibility 2017;52:132-137 Vancomycin/Zosyn Incompatibility Hosp Pharm Hospital Pharmacy 133T he combination of vancomycin hydrochloride and piperacillin-tazobactam is a commonly utilized antibiotic regimen for patients who require broad-spectrum antibiotic coverage, including patients with sepsis. 1 Vancomycin and piperacillin-tazobactam are commercially available as premix formulations in dextrose 5% water (D5W) with concentrations of 5 mg/mL and 67.5 mg/mL, respectively. 2,3 These premix formulations are theoretically advantageous because they minimize the preparation time required by pharmacy personnel and are able to be stored on medical floors in automated dispensing cabinets. Simultaneous infusion of these therapies is desirable in the clinical setting in order to reduce time to antibiotic administration and potentially improve patient outcomes. [4][5][6] Vancomycin and piperacillin-tazobactam have historically been considered to be Y-site incompatible at various concentrations. 7-10 However, rec...

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Physical compatibility of 4% sodium citrate with selected antimicrobial agents

Cited by 22 publications

References 7 publications

Stability and compatibility of antimicrobial lock solutions

Stability and compatibility of antimicrobial lock solutions

Comparative Effectiveness of Two Catheter Locking Solutions to Reduce Catheter-Related Bloodstream Infection in Hemodialysis Patients

Y-site Incompatibility between Premix Concentrations of Vancomycin and Piperacillin-Tazobactam: Do Current Compatibility Testing Methodologies Tell the Whole Story?

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