One-chamber and two-chamber parenteral nutrition admixtures for pediatric and adult patients: An evaluation of physico-chemical stability at room and cold temperature.

OBJECTIVES: The aim of this study was to evaluate the physico-chemical stability of compounded total parenteral nutrition admixtures through peroxidation assay and ultraviolet-visible spectroscopy, high-performance liquid chromatography analysis, nuclear magnetic resonance spectrometry, pH meter, and dynamic light scattering. METHODS: The present study considered parenteral nutrition (PN) admixtures for pediatric and adult patients. The admixtures were characterized by a high content of vitamins and trace elements. They were prepared in one- or two-chamber bags in the hospital pharmacy using an automatic compounding system in a sterile room with laminar airflow at different temperature conditions and light exposure. The experiment setup comprised fat emulsions, lipid-free PN solutions, and single-chamber bags before and after adding vitamins and trace elements. The stability at room temperature (+25°C) and cold temperature (+2-8°C) was assessed by various means. RESULTS: Two-compartment admixtures, single-chamber bags, and all-in-one PN supplemented with vitamins and trace elements are stable up until 35, 9, and 7 d, respectively, when protected from light and stored at +2 to 8°C. Also, the supplemented single-chamber PN was found to be stable up to 48 h when stored at +25°C with light exposure. CONCLUSIONS: The results obtained will help improve PN management at the compounding center and in hospital wards, because they allow for the extension of the validity time frame provided so far by the different formulations and, therefore, therapy scheduling over several days.

Antibiotic prophylaxis with a single dose of cefazolin during pacemaker implantation: incidence of long-term infective complications.

OBJECTIVE: Systemic and localized infections related to permanent pacemaker implantation are not common, but are serious and potentially life-threatening complications. The aims of this prospective observational study were: (1) to assess the safety and long-term efficacy of a simplified scheme of antibiotic prophylaxis, and (2) to identify the predictors of long-term infective complications, in patients undergoing pacemaker implantation or replacement. METHODS AND RESULTS: From October 1998 to July 2001, 852 patients (mean age 77.0 +/- 9.2 years; 474 men) who underwent new permanent pacemaker implantation (69.6%) or pulse generator replacement (30.4%) received a mini-bag of 2 g of cefazolin diluted in 50 mL of saline solution, administered intravenously in 20 minutes before the beginning of the procedure. Early (within 2 months of implantation) and late major and minor infective complications were recorded. During the earlier phase, minor complications were observed in 9 patients (1%). During the long-term phase of the surveillance (mean 25.6 +/- 11.0 months, range 12-55 months) major infective complications were observed in 6 patients (0.7%). On multivariate analysis, no clinical or procedural variable predicted the occurrence of long-term infective complications. CONCLUSIONS: Our data indicate the safety and efficacy of a single, intravenous 2 g dose of cefazolin in preventing infective complications related to pacemaker implantation or replacement. No clinical or procedural variable predicted the occurrence of long-term infective complications.