Sage Journals: Discover world-class research

Abstract

Spanish

French

BACKGROUND

Duration of intravenous fat emulsion (IVFE) infusions, precise method of administration (manufactured bottle vs repackaged syringe), and interval for administration set change continue to be debated.

OBJECTIVE

To determine the contamination rate associated with replacing IVFE administration sets every 24 hours in newborn infants receiving fat emulsion repackaged into unit-of-use syringes.

METHODS

This was a prospective, microbiologic study of 90 administration sets used in 19 neonates. IVFE samples were obtained from administration sets at the end of a 19– to 23–hour infusion and prior to daily tubing set change from infants who received repackaged IVFE. Samples of IVFE (1–3 mL) were aseptically removed at the catheter connection site proximal to the patient, transferred into BACTEC PEDSPlus culture media, and continuously monitored for 5 days to detect gram-positive and gram-negative organisms, as well as yeast.

RESULTS

Two samples (2.27%) grew coagulase-negative Staphylococcus. Both samples were from the same asymptomatic patient and were obtained on consecutive days. A blood sample obtained through this infant's central catheter grew the same organism and suggested catheter hub colonization as the primary site of microbe origin.

CONCLUSIONS

Microbial contamination of IVFE infusion sets changed at 24–hour intervals, using unit-of-use syringes in neonates, was low at 2.2%.

Keywords

intravenous fat emulsion sterility syringe

Get full access to this article

View all access options for this article.

References

1. A.S.P.E.N. Board of Directors. Nutrition support for low-birth-weight infants. JPEN J Parenter Enteral Nutr 1993;17(4):33SA–8SA.

2. Reiter

Thureen

PJ.

Nutrition support in neonatology. In: Gottschlich

Fuhrman

Hammond

Holcombe

Seidner

. The science and practice of nutrition support, a case-based core curriculum. 1st ed. Dubuque, IA: Kendall/Hunt, 2001:323–46.

3. Gilbertson

Kovar

Cox

Crowe

Palmer

NT.

Introduction of intravenous lipid administration on the first day of life in the very low birth weight infant. J Pediatr 1991;119:615–23.

4. O'Grady

Alexander

Dellinger

Gerberding

Heard

Maki

Guidelines for the prevention of intravascular catheter—related infections. MMWR Morbid Mortal Wkly Rep 2002;51(RR10):1–26.

5. Keammerer

Mayhall

Hall

Pesko

Thomas

RB.

Microbial growth patterns in fat emulsions. Am J Hosp Pharm 1983;40:1650–3.

6. Melly

Meng

Schaffner

Microbial growth in lipid emulsions used in parenteral nutrition. Arch Surg 1975;110:1479–81.

7. Marcon

Powell

DA.

Human infections due to Mallassezia spp. Clin Microbiol Rev 1992;5:101–19.

8. Scott

Gorman

Wyatt

Magill

EA.

Growth of microorganisms in total parenteral nutrition mixtures and related clinical observations. J Clin Hosp Pharm 1985;10:79–88.

9. Crocker

Noga

Filibeck

Krey

Markovic

Steffee

WP.

Microbial growth comparisons of five commonly used parenteral lipid emulsions. JPEN J Parenter Enteral Nutr 1984;8:391–5.

10.

10. Jarvis

Highsmith

AK.

Bacterial growth and endotoxin production in lipid emulsion. J Clin Microbiol 1984;19:1–20.

11.

11. Band

Naki

DG.

Safety of changing intravenous delivery systems at longer than 24 hour intervals. Ann Intern Med 1979;91:173–8.

12.

12. Ebbert

Farraj

Hwang

LT.

The incidence and clinical significance of intravenous fat emulsion contamination during infusion. JPEN Parenter Enteral Nutr 1987;11:42–5.

13.

13. Maki

Bottecelli

LeRoy

Thielke

TS.

Prospective study of replacing administration sets for intravenous therapy at 48- vs 72-hour intervals. 72 hours is safe and cost-effective. JAMA 1987;258:1777–81.

14.

14. Pharmaceutical compounding—sterile preparations. In: The United States pharmacopoeia and the national formulary. 21st ed. Rockville, MD: United States Pharmacopoeial Convention, 2003:3121–38.

15.

15. Data on file. Process sterility validation protocol A-15-03–03: TSB Media fill, lipid syringe filling process sterility validation. 2003–2004. CAPS, Denver, CO: B. Braun Medical.

16.

16. Elder

Laurel

Cumitech 31, verification and validation of procedures in the clinical microbiology laboratory. American Society for Microbiology, Washington, DC, 1997(2):11.

17.

17. Reiter

PD.

Sterility of intravenous fat emulsion in plastic syringes. Am J Health Syst Pharm 2002;59:1857–9.

18.

18. Bozzetti

Bonfanti

Regalie

Calligaris

Cozzaglio

Catheter sepsis from infusate contamination. Nutr Clin Pract 1990;5:156–9.

19.

19. Dolin

Davis

Holland

Turner

JA.

Contamination rates of 3–in-1 total parenteral nutrition in a clinical setting. JPEN J Parenter Enteral Nutr 1987;1:413–5.

20.

20. American Academy of Pediatrics Committee on Nutrition. Nutritional needs of low-birth-weight infants. Pediatrics 1985;75:976–86.

21.

21. American Academy of Pediatrics. Committee on Nutrition. Use of intravenous fat emulsions in pediatric patients. Pediatrics 1981;68:738–43.

22.

22. Matlow

Kitai

Kirpalani

Chapman

Corey

Perlman

A randomized trial of 72–hour versus 24–hour intravenous tubing set changes in newborns receiving lipid therapy. Infect Control Hosp Epidemiol 1999;20:487–93.

23.

23. Fox

Molesky

Van Aerde

Muttitt

Changing parenteral administration sets every 24 h versus every 48 h in newborn infants. Can J Gastroenterol 1999;13:147–51.

24.

24. Robathan

Woodger

Merante

A prospective study evaluating the effects of extending total parenteral nutrition line changes to 72 hours. J Intrav Nurs 1995;18:84–7.

25.

25. Mahieu

De Dooy

De Muynck

Van Melckebeke

Ieven

Van Reempts

PJ.

Microbiology and risk factors for catheter exit-site and -hub colonization in neonatal intensive care unit patients. Infect Control Hosp Epidemiol 2001;22:357–62.

26.

26. National Advisory Group on Standards and Practice Guidelines for Parenteral Nutrition. Safe practices for parenteral nutrition formulations. JPEN J Parenter Enteral Nutr 1998;22:49–66.