AimsThe objective of the study was to describe the impact of a clinical decision support system (CDSS) on antidiabetic drug management by clinical pharmacists for hospitalized patients with T2DM.MethodsWe performed a retrospective, single-centre study in a teaching hospital, where clinical pharmacists analysed prescriptions and issued pharmacist interventions (PIs) through a computerized physician order entry (CPOE) system. A CDSS was integrated into the pharmacists' workflow in July 2019. We analysed PIs during 2 periods of interest: one before the introduction of the CDSS (from November 2018 to April 2019, PIs issued through the CPOE alone) and one afterwards (from November 2020 to April 2021, PIs issued through the CPOE and/or the CDSS). The study covered nondiabetology wards as endocrinology, diabetes and metabolism departments were not computerized at the time of the study.ResultsThere were 203 PIs related to antidiabetic drugs in period 1 and 319 in period 2 (a 57.5% increase). Sixty-four of the 319 PIs were generated by the CDSS. Noncompliance/contraindication was the main problem identified by the CDSS (41 PIs, 68.4%), and 57.8% led to discontinuation of the drug. Most of the PIs issued through the CDSS corresponded to orders that had not been flagged up by clinical pharmacists using the CPOE. Conversely, most alerts about indications that were not being treated were detected by the clinical pharmacists using the CPOE and not by the CDSS.ConclusionUse of CDSS by clinical pharmacists improved antidiabetic drug management for hospitalized patients with T2DM. The CDSS might add value to diabetes care in nondiabetology wards by decreasing the frequency of potentially inappropriate prescriptions and adverse drug reactions.

Objectives. - To perform an ergonomic intervention using the methodology of the analysis of the activity of the training process of clinical pharmacy residents in the analysis of prescriptions. Methods. - The evaluation was carried out over two semesters: from May to October 2016 (first study) and from November 2016 to April 2017 (second study). The interviews and observations were conducted by an ergonomist who is an expert in this type of evaluation. The first study was based on observations of the training process and interviews at different time. The second study allowed to support pharmacists and evaluate the changes following the recommendations of the previous study. Results. - A total of 6 and 9 residents participated in the first and second study, respectively. During the first study, 6 difficulties were raised which allowed implementation decisions. Feedback from residents on the training process was generally positive for the first part of the training but negative for the last part. The average number of fears expressed by the residents was higher at the beginning (2.9 fears) than at the end (1 fear). Conclusions. - The training process has been adapted to the expectations and feelings of the residents. Follow-up at the beginning and throughout the internship was essential. The next stage of this work will be to evaluate the contribution of the dashboards for monitoring clinical pharmacy skills in the new degree for hospital pharmacy. (c) 2021 Academie Nationale de Pharmacie. Published by Elsevier Masson SAS. All rights reserved.

L’arrivée des thérapies ciblées orales (TCO) dans l’arsenal thérapeutique des cancers bronchiques non à petites cellules a fait apparaître la problématique de leur gestion ambulatoire. L’éducation du patient sur ces traitements pourvoyeurs d’effets indésirables et d’interactions médicamenteuses est primordiale. Afin d’optimiser la prise en charge médicamenteuse du patient, des entretiens pharmaceutiques sont menés lors de l’initiation et au cours du suivi mensuel de ces TCO. L’objectif de ce travail est d’évaluer l’intérêt des entretiens pharmaceutiques aussi bien à l’initiation qu’au suivi des patients sous TCO, par l’analyse des interventions pharmaceutiques (IPs) réalisées au cours de ces entretiens. Une étude rétrospective, portant sur les IPs réalisées à l’introduction et au suivi des TCO, a été menée dans le service d’oncologie thoracique durant 6 mois. Les entretiens pharmaceutiques étaient réalisés selon les recommandations émanant de la Société Française de Pharmacie Oncologique. Le nombre d’IPs est relevé à l’issue de chaque entretien. Trente-cinq patients (âge moyen 66 ± 12 ans) ont bénéficié d’entretiens pharmaceutiques. Le sexe ratio Homme/femme est de 46 %. Au total, 83 entretiens ont été réalisés. À l’initiation, 36 IPs ont été formulées, soit 1 IP par entretien (80% étaient en lien avec la TCO). La majorité des IPs portaient sur une interaction médicamenteuse (55 %), avec pour conséquence l’arrêt du médicament ou l’optimisation des modalités d’administration dans 35 % et 29 % des cas, respectivement. La totalité de ces IPs étaient en lien avec la TCO. Les inhibiteurs de pompes à protons sont les principales causes des IPs dans 28% des cas, toutes en lien avec la TCO. Concernant le suivi, chaque patient avait en moyenne 1,5 entretiens. Au total, 18 IPs ont été réalisées soit 0,35 IP par entretien (72 % sont en lien avec la TCO). La présence d’interactions médicamenteuses et l’arrêt d’un médicament lié à la présence de la TCO représentaient 28 % et 55 % des IPs, respectivement. L’absence d’indication traitée représentait 28 % des IPs, avec un lien possible avec la TCO dans 40 % des cas. Au total, 96 % des IPs formulées auprès de l’équipe médicale était acceptée. Ce travail a montré l’importance des entretiens pharmaceutiques à l’initiation des TCO, vecteurs d’un grand nombre d’IPs. Afin de garantir la continuité de la bonne prise en charge des patients, les entretiens de suivi des patients demeurent importants au vu des IPs réalisées lors de cette étude.

The characterization of drug-drug interactions (DDIs) may require the use of several different tools, such as the thesaurus issued by our national health agency (i.e., ANSM), the metabolic pathways table from the Geneva University Hospital (GUH), and DDI-Predictor (DDI-P). We sought to (i) compare the three tools’ respective abilities to detect DDIs in routine clinical practice and (ii) measure the pharmacist intervention rate (PIR) and physician acceptance rate (PAR) associated with the use of DDI-P. The three tools’ respective DDI detection rates (in %) were measured. The PIRs and PARs were compared by using the area under the curve ratio given by DDI-P (RAUC) and applying a chi-squared test. The DDI detection rates differed significantly: 40.0%, 76.5%, and 85.2% for ANSM (The National Agency for the Safety of Medicines and Health Products), GUH and DDI-P, respectively (p < 0.0001). The PIR differed significantly according to the DDI-P’s RAUC: 90.0%, 44.2% and 75.0% for RAUC ≤ 0.5; RAUC 0.5–2 and RAUC > 2, respectively (p < 0.001). The overall PAR was 85.1% and did not appear to depend on the RAUC category (p = 0.729). Our results showed that more pharmacist interventions were issued when details of the strength of the DDI were available. The three tools can be used in a complementary manner, with a view to refining medication adjustments.

Objectives The objectives were to compare clinical pharmacist interventions between two care groups: COVID-19-positive and COVID-19-negative patients, and to identify drugs that require particular attention, especially those involved in COVID-19 management. Methods A prospective cohort study was conducted on patients with positive and negative COVID-19 statuses admitted to Lille University Hospital over 1 month. Pharmaceutical analysis instigated interventions to rectify drug-related errors. For each pharmaceutical intervention (PI), the anatomical therapeutic chemical classification of the drug and the outcome of such an intervention were specified. Results The study included 438 patients. Prescription analysis led to 188 PIs performed on 118 patients (64 COVID-19-positive patients and 54 COVID-19-negative patients). Most drug-related problems were incorrect dosage representing 36.7% (69/188) of all interventions: 27.9% (29/104) for the COVID-19-positive group and 47.6% (40/84) for the COVID-19-negative group. The most frequent PI in 34% (64/188) of cases was terminating a drug: 27.9% (29/104) for the COVID-19-positive group and 47.6% (40/84) for the COVID-19-negative group. The main drug classes involved were antithrombotic agents (20.7%, 39/188), antibacterials for systemic use (13.8%, 26/188) and drugs for gastric acid-related disorders (6.4%, 12/188). Study population was limited to a single centre over 1 month. Conclusion No difference in PI was noted between the two groups. The presence of pharmacists led to a reduction in drug-related prescription problems, especially for antithrombotic and antibacterial drugs for both groups. Clinical pharmacy commitment in such a pandemic is therefore important.

Une expérimentation de coopération entre pneumologues et pharmaciens hospitaliers a été menée dans un service de pneumologie du CHU de Lille afin de sécuriser le parcours de soins en travaillant sur les points critiques de transition (entrée, sortie). Ce travail vise à évaluer l’impact de l’intervention du pharmacien (IP) (action induisant directement une modification de la prise en charge du patient ou de sa thérapeutique médicamenteuse) dans cette sécurisation du parcours des patients hospitalisés pour exacerbation sévère de leur asthme. Étude prospective et monocentrique sur 4 mois, incluant tout patient > 18 ans hospitalisé pour exacerbation d’asthme. Des entretiens pharmaceutiques étaient réalisés à l’admission et à la sortie du patient (conciliations médicamenteuses) avec appel systématique du pharmacien officinal du patient. Les caractéristiques sociodémographiques des patients ont été recueillies. Les erreurs de prescription à l’admission et/ou de retranscription dans le courrier de sortie ont été relevées, à partir desquelles une IP était proposée au pneumologue. Au total, 37 patients ont été inclus (âge 56 ± 17,1 ans, sex-ratio H/F 0,61, IMC 30,1 ± 9,7 kg/m2). Le VEMS était de 55,8 ± 20,4 %. À l’admission, nous avons relevé 8,4 ± 5,2 médicaments par patient. Au total, 49 erreurs ont été identifiées par rapport au traitement à domicile, soit 1,3 ± 1,2 erreurs par patient. Les IPs ont consisté en une adaptation posologique, un ajout, une substitution, une optimisation des modalités d’administration et un arrêt du traitement dans 38,8 %, 26,5 %, 16,3 %, 12,2 % et 6,1 % des cas, respectivement. Toutes ont été acceptées par le pneumologue. Au total, 75,7 % des patients ont bénéficié d’un entretien de sortie, ce qui a permis de relever 31 erreurs. Les IPs ont consisté en un ajout, une adaptation posologique, une substitution, une optimisation des modalités d’administration et un arrêt du traitement dans 32,3 %, 22,6 %, 19,4 %, 19,4 % et 6,5 % des cas, respectivement. Le taux d’acceptation des IPs est de 96,8 %. La majorité des erreurs détectées à l’admission et la sortie portait sur les médicaments à visée respiratoire (selon la classe ATC) dans 38,8 % et 29,0 % des cas, respectivement. Le détail des erreurs figure dans le Tableau 1. La bonne coopération entre pneumologue et pharmacien a permis de corriger de nombreuses divergences aux points critiques de transition des patients asthmatiques. Il serait intéressant de définir un plan d’action afin de prévenir ces erreurs.

La prise en charge des cancers bronchiques a beaucoup évolué ces dernières années, avec l’avènement des thérapies ciblées orales (TCO). Néanmoins, leur utilisation a fait apparaître de nouvelles problématiques dans la prise en charge ambulatoire des patients de plus en plus âgés et polymédiqués, notamment de par leurs spécificités pharmacologiques (interactions avec médicaments/alimentation, risque de mauvaise adhérence, automédications). En réponse à ces complexités, des consultations pharmaceutiques ont été mises en place. Le but de ce travail est d’évaluer l’impact de ce type de consultations au sein d’un service de pneumologie. Étude prospective et monocentrique portant sur des consultations pharmaceutiques lors de primo-prescriptions et de suivi à M1, M2 et M6 de 11 TCO différentes. Chaque entretien consistait en un apport d’informations sur la TCO au patient, les effets indésirables et leur gestion, la réalisation d’un bilan médicamenteux optimisé en vue d’intégrer les comportements de santé du patient (automédication, alimentation) et prévenir le risque potentiel d’interactions avec la TCO. À l’issue de l’entretien, toutes interventions pharmaceutiques (IPs) étaient transmises aux pneumologues et tracées. Au total, 115 entretiens ont été réalisés, dont 97 % en hospitalisation programmée, incluant 63 patients (âge 63,4 ± 11,8 ans, sex-ratio H/F 0,77, IMC de 27,3 ± 8,4 kg/m2). La majorité (85,7 %) des patients vivent en zone urbaine, avec accès immédiat à une pharmacie. Cinquante-six entretiens reposaient sur une initiation de TCO, dont 9 (16,1 %) portaient sur une modification de TCO. Cinquante-sept entretiens de suivi ont été réalisés, dont 25 (43,9 %), 10 (17,5 %), 7 (12,3 %) et 15 (26,3 %) à M1, M2, M6 et autres périodes, respectivement. Avant initiation de la TCO, chaque patient avait en moyenne 6,0 ± 4,2 médicaments à domicile. Parmi les patients, 54,0 % et 30,2 % avaient recours à l’automédication et à la phytothérapie, respectivement. À l’issue des entretiens, 149 IPs ont conduit à une modification thérapeutique de l’ordonnance du patient, soit 1,30 IPs par consultation. Les IP réalisées étaient directement imputées à la présence d’une TCO dans 77,2 % des cas, dont une majorité concernait (74 ; 64,3 %) des problèmes d’interactions avec la TCO. L’ensemble des IPs est détaillé dans le Tableau 1. Les consultations pharmaceutiques, associées à une bonne coopération avec les pneumologues, ont permis d’améliorer la prise en charge globale des patients sous TCO.

OBJECTIVE:The aim of this review is to analyse the clinical consequences of intravenous drug incompatibilities in critically ill patients, especially the incidence of organ dysfunctions and mortality. METHODS:A review of literature was conducted according to the PRISMA statement in June 2017, using Medline, ISI Web of Science and Clinicaltrials.gov. DATA EXTRACTION:Eligible studies were case reports and randomised controlled trials (RCTs) that assessed the effects of drug incompatibilities in critically ill patients on morbidity or mortality as primary or secondary outcomes, or adverse events. Two investigators independently reviewed the eligibility of the study from abstracts or manuscript data. DATA SYNTHESIS:Twelve articles met the selection criteria. The six articles reporting RCTs concern only four RCTs. RCTs were single-centre studies comparing infusion with or without filter. One of them included adult patients. The others included paediatric and neonatal intensive care unit patients. Primary endpoints were SIRS, organ failure, overall complication rate, bacteraemia, sepsis, phlebitis and length of stay. The results are mixed with one RCT reporting a reduction in SIRS, organ failure and overall complication rate, two studies in disagreement over the occurrence of sepsis and one study reporting no impact on length of hospital stay. The six articles on case reports show different drug incompatibility situations. They report pulmonary toxicity. CONCLUSION:Little data is available on this topic. Infused particles may induce organ failure, in particular pulmonary toxicity and SIRS. Further studies are needed to establish a link between the level of exposure to drug incompatibilities and clinical implication.

Les principaux traitements de la BPCO sont sous forme inhalée. Des dispositifs inadaptés ou mal utilisés peuvent entraîner une perte d’efficacité, avec un risque d’exacerbation et donc de réhospitalisation. L’objectif est d’évaluer l’impact d’une coopération entre pneumologue et pharmacien hospitalier dans l’optimisation des traitements des patients BPCO. Des patients BPCO hospitalisés en pneumologie et bénéficiant d’au moins un traitement inhalé de longue durée d’action ont bénéficié de consultations pharmaceutiques permettant de recueillir les classes pharmacologiques, le nombre d’inhalateur(s) de longue durée d’action avant l’hospitalisation et à la sortie, et la gestuelle associée à la prise du dispositif. Ils sont sélectionnés sur demande du médecin ou proposition du pharmacien au regard d’une introduction récente (< 1 mois) d’un dispositif, d’une mauvaise observance (score de GIRERD > 1) et/ou d’exacerbations fréquentes. Lors de l’entretien, le pharmacien apprécie la maîtrise de l’inhalation et dispense des informations relatives au bon usage. Des interventions pharmaceutiques (IP) (action induisant directement une modification de la prise en charge du patient ou de sa thérapeutique médicamenteuse) ont été menées auprès des pneumologues lorsque nécessaire et répertoriées. Quarante-quatre patients BPCO ont été vus par des pharmaciens sur 4 mois (âge médian 66 ans [min 44, max 90], sex-ratio H/F 2,2). Quinze patients étaient sous triple thérapie à l’entrée, contre 10 à la sortie d’hospitalisation. La double bronchodilatation concernait 11 et 18 patients, respectivement. Les patients disposaient de 1, 2 ou 3 inhalateur(s) à l’admission dans 43,2 %, 34,1 % et 9,1 % des cas, respectivement, contre 75,0 %, 22,7 % et 0 % des cas à la sortie. Au total, 70,5 % des patients ont eu un rappel sur la gestuelle de leur dispositif. Ces rappels n’ont pas été comptés en tant qu’IP (car considérés comme soins courants). Au total, 17 IP ont été réalisées chez 15 patients de la cohorte, portant sur l’optimisation du dispositif d’inhalation dans 70,6 % des cas ou de la pharmaco-thérapeutique (29,4 %). Le détail des IP figure dans le Tableau 1. Toutes les IP ont été acceptées après discussion avec les pneumologues. Cette étude a permis de montrer que la présence pharmaceutique en pneumologie pouvait aider à optimiser les thérapeutiques inhalées tant sur la gestuelle que sur l’observance. Il pourrait être intéressant de faire une étude de l’impact de cette coopération en termes de ré-exacerbations et financier.

In critically ill patients, drug incompatibilities frequently occur because of the number of drugs to be administered through a limited number of infusion lines. These are among the main causes of particulate contamination. However, little data is available to quantify particle exposure during simultaneous IV-drug infusion. The objective of this study was to evaluate the particulate matter potentially administered to critically ill patients.

The large number of drugs administered simultaneously to neonates and children in hospital results in the formation of particles that are potentially infused. We have investigated the ability of IV in-line filters to eliminate particulate matter from multidrug infusion lines and so prevent contamination. The impact on particle occurrence of the internal volume of the IV line below the in-line filter was then evaluated. The multidrug therapy given to children was reproduced with and without in-line filtration. Three combinations with a filter were tested to vary the internal volume (V) between the filter and the catheter egress. The catheter was then connected to a dynamic particle count to evaluate the particulate matter potentially administered to children during infusion. The introduction of in-line filters led to a significant reduction in overall particulate matter, from 416,974 [208,479–880,229] to 7,551 [1,985–11,287] particles (p < 0.001). Larger particles of ≥10 and 25 µm were also significantly reduced. Adding an extension set to the egress of the in-line filter (V = 1.7 mL) caused a significant increase in particulate contamination for both. This study showed that in-line filtration is an effective tool in preventing particle administration to patients. Their position in the infusion in-line is therefore important because of its impact on internal volume and drug particle formation.

The administration of several intravenous products on the same catheter is a very common situation in neonatology, where the stakes are high and the dangers sometimes unknown to clinicians. A large number of factors are involved in this administration, directly related to the installation of the infusion line. Moreover, the therapeutics used are often limited, and excluding classic “Marketing Authorization”. Some of these products may prove to be incompatible and thus lose their effectiveness, or even generate particles that are likely to be administered to the patient. We must be aware of these risks in order to optimize the prescription and administration of these intravenous products, especially as we treat fragile and immature patients. The aim of this work is to review the literature on the subject for the prescribers of neonatology units.

Le lacosamide est indiqué dans la prise en charge des crises partielles avec ou sans généralisation secondaire, mais l’usage de la forme IV dans les situations d’urgence reste mal codifié. Identifier les indications ainsi que les modalités d’administration (bolus et/ou titration, posologie, durée) du lacosamide IV prescrites au CHRU de Lille chez les patients adultes, tous services confondus. Il s’agit d’une étude prospective, observationnelle, non interventionnelle et monocentrique, menée durant 6 mois. Tous les services du CHRU de Lille ont été inclus. Les caractéristiques des patients (âge, sexe, poids), les indications, les posologies (bolus et/ou titration), la durée de traitement ainsi que les modalités de relai entre les voies IV et per os ont été relevés. Trente-huit patients ont été inclus (sex-ratio 0,73). L’âge médian est de 68 ans [39 ; 93] et le poids médian de 72 kg [47 ; 105]. Parmi les patients, 55,3 % étaient des épileptiques connus. L’administration IV du lacosamide concernait 13 états de mal épileptique partiel (34,2 %), 16 crises répétées (42,1 %) et 9 cas de voie orale impossible (23,7 %). Seuls 13,2 % des patients ont reçu un bolus de 200 mg de lacosamide et 57,9 % ont bénéficié d’un relai per os. Un tiers des prescriptions de lacosamide IV concernaient des patients en état de mal épileptique partiel, pour lequel il n’existe pas de recommandation formalisée sur l’utilisation du lacosamide par voie IV. Notre étude a mis en exergue une hétérogénéité des pratiques entre les services de soins, notamment sur les doses utilisées en bolus et les modalités de relai per os. Le lacosamide administré par voie IV pourrait avoir sa place dans la stratégie de prise en charge de l’état de mal épileptique partiel, mais une harmonisation des pratiques s’avère indispensable.

Studies have shown that infused particles lead to numerous complications such as inflammation or organ dysfunctions in critically ill children. Nevertheless, there is very little data available to evaluate the amount of particulate matter potentially administered to patients, and none with regard to infants. We have investigated the quantity received by these patients during multidrug IV therapies. Two different protocols commonly used in our neonatal intensive care unit (NICU) to manage excessively preterm infants were reproduced in the laboratory and directly connected to a dynamic particle analyser. The particulate matter of infused therapies was measured over 24 h, so that both overall particulate contamination and particle sizes could be determined. No visible particles were observed during drug infusions. Particulate analyses showed a significant number of particles that can reach 85,000 per day, with peaks during discontinuous drug infusions. Moreover, we showed that very large particles of about 60 µm were infused to infants. This study showed that despite very low infusion flow rates, infants may receive a large number of particles during drug infusion, especially in NICUs. Particulate contamination of IV fluids is not without consequences for fragile infants. Preventive solutions could be effective, such as the use of in-line filters.

One of the fundamental principles guiding the pharmaceutical quality of parenteral products is to prevent injecting contaminants from microbiological, chemical or physical sources. It is just as difficult to ensure the absence of chemical and particulate contaminants in injectable products as it is to weigh up the microbiological risk. The problem of particulate matter is mainly related to the preparing and administrating of injectable drugs rather than through the contamination of marketed products. Particulate contamination also arises in situ during the simultaneous intravenous (IV) infusion of incompatible drugs. A complete overview of these problems in the context of IV infusion was carried out to assess their clinical impact. Many studies had already been performed on this theme, but the majority date from the 1970s and 1980s. Clinicians have expressed a renewed interest since the early 2000s, focusing on the impact of particles on patients.

Background Drug incompatibilities, such as precipitates, may contribute to the clinical deterioration of paediatric patients (sepsis), especially when infusing vancomycin and piperacillin (VAN/PIP). Drug concentration and infusion sets affect the overall particulate contamination of paediatric infusion protocols. Using multilumen infusion sets could prevent these incompatibilities. Purpose To define and assess a new way to infuse VAN/PIP during leukaemia treatment in paediatric patients, without any visible precipitate. Material and methods Two infusion sets were studied, which differed in design and drug dead-space volume (V): 1) a standard single lumen set with 2 four-port manifolds with extension lines (ref RPB4320, Cair LGL, France; V ∼ 12 mL) and 2) a 5-lumen infusion set (ML-5) (Edelvaiss-Multiline, Doran International, France; V ∼ 1 mL). Different vancomycin concentrations (VANc) were tested to infuse VAN/PIP simultaneously without any precipitate (optimised multidrug protocol). A dynamic particle count test was performed (N = 5) over 24 h to evaluate the overall particulate contamination of our standard (VANc = 42 mg/mL) and optimised (VANc = 4 mg/mL) protocols, using both standard and ML-5. We performed a t-test. Results No visible particles were detected on reducing VANc (4 mg/mL) instead of the standard dose (42 mg/mL). For the optimised multidrug protocol, using the ML-5 reduced the overall particulate contamination by 68%, compared to the standard infusion set (716,349 ± 89,322 vs. 251,980 ± 49,429; p = 0.002). The number of large particle sizes was significantly reduced when using the ML-5 ∼ 60% (p = 0.027) and 90% (p = 0.009) for particle sizes ≥10 and 25 µm, respectively. Conclusion This study demonstrated the large number of particles administered during parenteral multidrug infusion. This can be minimised through the choice of the drug concentration and/or the type of infusion set. Although this kind of contamination is invisible, further studies are required to evaluate its adverse clinical impact. References and/or acknowledgements No conflict of interest.

An in vitro study was carried out to determine the anti-Xa activity of heparin in binary parenteral nutrition (BPN) admixtures for premature neonates in our neonatal intensive care unit (NICU) after a 24-hour infusion, as well as to assess drug interaction with a 50% glucose solution. Two types of bags were prepared: (1) BPN admixtures (composition defined in the NICU) including sodium heparin at 77 UI/mL and (2) bags containing only G50% with sodium heparin at 193 UI/mL. The anti-Xa activity of heparin was measured in bags at T0, after the 24-hour infusion and in eluates at the outlet of the infusion line after 24hours, using a validated chromogenic anti-Xa method. Comparisons of the mean concentration observed with the theoretical value for anti-Xa activity were performed with the Student t-test. Mean values of anti-Xa activity do not differ significantly from the values expected for all conditions. We found a slight variation in anti-Xa activity when infused over 24hours for both types of bags, with and without in-line filtration, showing that heparin remains stable during this infusion period in both BPN admixtures and G50%.

BACKGROUNDThe repeated blackening of in-line filters has been observed during the infusion of parenteral nutrition 2-in-1 mixtures (binary parenteral nutrition [BPN]) delivered in a neonatal intensive care unit. This study aimed to examine the elemental content of precipitates isolated from infused BPN bags and determine the main physicochemical interactions occurring in these bags.MATERIALS AND METHODSThe infusion of BPN mixtures was simulated in vitro following hospital practices. Filter membranes were examined by scanning electron microscopy and energy dispersion spectroscopy (EDS). Amino acid (AA) profiles were obtained from BPN mixtures to determine the concentrations of each AA.RESULTSAnalyzed filter membranes revealed conglomerates of particles on filter surfaces. An EDS analysis generated spectra from isolated particles, identifying copper and sulfur as the major chemical elements. AA mean concentrations were relatively close to the expected value for each AA, except cysteine. Cysteine concentrations were very significantly lower than the expected values.CONCLUSIONA specific interaction was identified between 1 AA (cysteine) and a trace element (copper) in our BPN mixtures.

Objective: Drug incompatibilities can jeopardize the safety and effectiveness of intravenous drug therapies, especially in the field of anaesthesia and intensive care. Patients receive many drugs simultaneously through limited venous accesses. This study was designed to confirm the impact of a multilumen infusion device on the occurrence of known physical drug incompatibilities.Study design: In vitro laboratory work.Methods: Two infusion devices were studied: a standard single-lumen set and a multilumen infusion access device (Edelvaiss Multiline-8, Doran International). Up to six drugs were infused simultaneously: three acidic solutions of midazolam, amiodarone and dobutamine, and three alkaline solutions of furosemide, pantoprazole and amoxicillin/clavulanate. Saline, Ringer' solution and 5% dextrose were used as hydration vehicles with an infusion rate initially set at 100 mL/h and with stepwise decreases of 10 mL/h until precipitation. Two methods were used to highlight physical drug compatibility according to the European Pharmacopoeia: visual inspection of the extension set and an obscured-light sub-visible particle count test of infusions. The lowest infusion rate value for vehicle infusion to satisfy the two tests in all trials is reported for each infusion device.Results: The standard set did not satisfy the test in 82% of the assessed drug combinations. The Edelvaiss Multiline-8 was able to prevent the occurrence of drug incompatibilities in 49% of the drug combinations tested. This device is therefore advantageous, especially when simultaneously infusing two or four incompatible drugs.Conclusions: Infusion device characteristics have an impact on physical drug incompatibilities. Our results confirm that the Edelvaiss Multiline-8 device prevents physical drug incompatibilities under specified conditions. (C) 2015 Societe francaise d'anesthesie et de reanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.

BackgroundDrug incompatibilities, recognizable through precipitate, may have clinical consequences for patients, especially during multidrug IV therapies, where vancomycin and piperacillin are present. Drug concentration and infusion set influence the overall particulate contamination of pediatric infusion protocols. The use of multi-lumen infusion sets could prevent such incompatibilities. Our goal was to define and assess a new way to infuse these drugs during leukemia treatment in children.ProceduresThis in vitro study focused on a pediatric multidrug protocol for patients diagnosed with lymphoblastic leukemia and receiving allogeneic transplantation. Different vancomycin concentrations were tested to infuse incompatible drugs simultaneously without any particle formation (optimized multidrug protocol). A dynamic particle count test was used over 24hr to evaluate the overall particulate contamination of our standard and optimized multidrug protocols, using both a standard and a multi-lumen infusion set.ResultsNo visible particles were detected on a decreased vancomycin concentration compared to the standard dose. For the optimized multidrug protocol, the use of a multi-lumen infusion set reduced overall particulate contamination by 68%, compared to the standard infusion set (P=0.002). Large-sized particles were significantly reduced when using the multi-lumen infusion set approximately 60% (P=0.027) and 90% (P=0.009) for particle sizes 10m and 25m, respectively.ConclusionsThis study demonstrates that a large number of particles can be administered during parenteral multidrug infusion. The choice of drug concentration and/or the type of infusion set may reduce this. Further studies are required to evaluate adverse clinical effects. Pediatr Blood Cancer 2015;62:1042-1047. (c) 2015 Wiley Periodicals, Inc.