儿科临床开放式和封闭式输液使用的对比实验

目的：对开放式和封闭式输液的微生物和微粒污染状态进行对照比较。方法：按中国药典不溶性微粒和微生物法进行测定。结果：两种输液中微生物污染无显著差异。但不溶性微粒污染有显著差异。结论：封闭式输液在微粒污染方面明显少于开放式输液。     

静脉输液调配中心环境与自然环境输液调配后不溶性微粒数量对比研究

目的探讨静脉输液调配中心环境(PIVAS)与自然环境下输液调配不溶性微粒的变化。方法两种环境下分别向5%葡萄糖注射液、0.9%氯化钠注射液中,按1支/次的速度,分1⁵次,加入肌苷注射液15次,加入肌苷注射液1⁵支,然后检测不溶性微粒并进行比较。结果两种环境下调配的输液检测结果表明,PIVAS环境下所调配的输液中,≥10μm不溶性微粒的污染粒数明显少于自然环境下所调配的输液中的粒数,两项比较有非常显著差异(P<0.01);≥25μm不溶性微粒的污染粒数也相对较少。两种环境下加药次数3次以上与加药1次进行比较均有显著差异(P<0.05)。结论在输液调配过程中,PIVAS环境可明显减少不溶性微粒数量。建议医疗机构应大力提倡PIVAS环境下进行输液调配。     

不同输液系统和加药条件对输液中微生物及不溶性微粒的影响

目的通过有关实验．阐明不同输液系统和不同加药条件下对输液中的微生物及不溶性微粒的影响。方法采用在一定的温、湿度的条件下．在不同的洁净环境中测定输液加药前后及在一定环境中模拟输液过程不溶性微粒和微生物的污染。结果在不同的环境中输液加药的污染程度及在一定环境中模拟输液过程存在统计学方面的差异。结论改变医院现有的输液配置模式及输液系统,是保证患者用药安全有效的重要前提。     

静脉输液不溶性微粒监测体系的建立研究

目的对静脉输液操作过程中可能造成不溶性微粒污染的各环节进行监测,探讨减少造成不溶性微粒污染的途径。方法进行输液器质量、进气方式、空气环境、配药环境、配药用具和加入各种针剂与不溶性微粒污染的相关性试验,利用注射液微粒分析仪测定各样品的不溶性微粒数。结果不同厂家输液器配制的输液所含不溶性微粒数存在显著性差异(P<0.01),进气方式、空气环境、配药环境、配药用具、以及加入各种针剂的不同,亦可引起不同程度的不溶性微粒污染(P<0.01)。结论常规静脉输液过程的各环节均有可能导致数量和大小不等的不溶性微粒污染,应加强输液操作各环节的质量管理,尽量采用能避免不溶性微粒污染的操作方式,尽快建立静脉输液配置中心。     

一次性输液器对输液质量的影响

一次性输液器对输液质量的影响田伟强，吴华芬，陈高梁（浙江省丽水地区人民医院龙泉３２３７００）输液中不溶性微粒对人体危害极大。中国药典规定了对输液进行微粒检查。为防止输液过程污染，一次性输液器装有空气过滤器和终端滤器，以阻止微粒和微生物进入。为检验其效...     

考察配伍前后输液中的不溶性微粒

目的考察配伍前、后输液中不溶性微粒的变化。方法采用自动微粒分析仪测定输液配伍药物前、后的不溶性微粒数。结果与结论输液配伍药物后微粒显著增加,配伍药品数越多,微粒污染越严重。     

静脉输液与不溶性微粒监测体系建立的探讨

目的：探讨在静脉输液治疗过程中出现液体污染产生不溶性微粒的原因。方法：对静脉输液应用过程中产生不溶性微粒进行检测并建立监控体系。结果：静脉输液在配置使用的过程中,由于药物配伍、环境、操作、输液器具等因素影响,不溶性微粒明显增多。结论：常规静脉输液的各环节均有可能致数量和大小不等的不溶性微粒污染,应加强输液操作各环节质量管理,尽量采用避免不溶性微粒污染的操作方式,建立静脉输液配置中心。     

半开放式静脉输液器2种排气方式对药液中不溶性微粒污染的影响

目的:比较半开放式静脉输液器2种排气方式对药液中不溶性微粒污染的影响情况。方法:模拟临床输液操作,分别采用上、下部排气方式对半开放式静脉输液器进行排气,同时对药液中不溶性微粒进行检测。结果:经检测,≥10μm的不溶性微粒,上、下部排气方式结果分别为(3.11±0.82)、(4.21±0.87)个/mL,t值为3.985,P=0.000;≥25μm的不溶性微粒,上、下部排气方式结果分别为(0.19±0.90)、(0.36±0.10)个/mL,t值为2.374,P=0.000。2种排气方式比较差异具有统计学意义(P<0.01)。结论:半开放式静脉输液器采用上部排气方式对减少药液不溶性微粒方面优于下部排气方式。     

常用中药注射剂与输液配伍前后不溶性微粒变化及其相关安全性研究（摘要）

目的：研究常用中药注射剂与不同厂家输液配伍前后不溶性微粒变化,从微粒污染方面考察中药注射剂临床应用的安全性。方法：调研临床上常用的中药注射剂,采用《中国药典》（2005年版）附录光阻法测定配伍前输液中及中药注射剂与输液配伍后不溶性微粒的数量。结果：配伍后,混合溶液中不溶性微粒的数量与配伍前输液中的数量相比（尤指粒径≥2um和≥5um的微粒）均显著增加,     

对输液反应残留液不溶性微粒数的考查

目的:研究输液反应残留液过滤前、后不溶性微粒数的变化情况。方法:利用微粒分析仪测定几种输液反应残留液的不溶性微粒数和经空白输液器再次过滤后的不溶性微粒数,同时对空白液体测定其过滤前及用残留输液器过滤后的不溶性微粒数。结果:残留液的不溶性微粒数显著增高,经空白输液器过滤后不溶性微粒数明显减少,而空白液体经残留输液器过滤后不溶性微粒数也明显增高。结论:临床使用注射剂静脉滴注时,应考虑微粒相加问题;建议输液器中再增加一个过滤器。     

The availability of nitroglycerin from parenteral solutions

The availability of nitroglycerin from solutions infused from Viaflex plastic infusion bags or glass infusion bottles through Buretrol plastic giving sets has been examined. Each of the individual components of the infusion bag/giving set system (i.e. infusion bag, burette and infusion tubing) sorbed nitroglycerin to a significant extent. It was found that the extent and rate of nitroglycerin disappearance from solutions stored in each of the components were in the rank order: tubing > burette > infusion bag. The disappearance kinetics of nitroglycerin from solutions stored in each component was more accurately described by a ‘diffusion’ model than by the ‘two compartment kinetic’ model reported previously. The dimensions of the components and the volume of solution used were determinants of the rate and extent of nitroglycerin disappearance. In simulated infusions of nitroglycerin through plastic infusion bag (or glass bottle)/giving set system the flow rate of solution through the plastic infusion tubing affected the concentration of nitroglycerin in the effluent and the extent of sorption by the components of the infusion delivery system. The loss of nitroglycerin in these studies could be accounted for solely by the sorption of nitroglycerin by the plastic components of the infusion bag/giving set system.     

BFS基础输液微生物负荷实验研究

目的：考察BFS基础输液微生物负荷,并与其他包装工艺进行比较。方法：根据BFS,软袋、塑瓶3种不同包装工艺的特点,选择容器、过滤终端和灌装过程3个取样点,对某公司生产的上述3种不同包装的5%葡萄糖注射液共计61批样品,采用TSA培养基两个温度点培养的方法检测微生物负荷;采用沸水浴30min,薄膜过滤法处理,硫乙醇酸盐肉汤培养基30~35℃培养7d的方法,检测耐热微生物。结果：20批次BFS样品中均未检出耐热微生物;BFS样品灭菌前药液微生物污染水平低于软袋、塑瓶样品。结论：BFS基础输液在微生物负荷控制方面较其他包装工艺产品具有优势。     

Contamination of platelet storage bags by phthalate esters

Phthalate esters are the most extensively used plasticizers in the manufacture of polyvinylchloride (PVC) plastic. Many medical devices used in the collection and storage of blood components are made of PVC plastic containing di(2-ethylhexyl) phthalate (DEHP). DEHP leaches at a rate of 100 micrograms/ml X d into platelet concentrate (PC) supernatant when PCs are stored in PVC containers. It is only possible to store PCs for 72 h in this DEHP plastic, after which time the platelet function has deteriorated and they cannot be used for transfusion therapy. Since it was desirable to find a container that permitted longer storage times and because of the concern for the toxicity of DEHP, new bags, manufactured with different plastic formulations without this plasticizer, were tested for PC storage. Using these new containers, such as the PL732 [polyolefin (PO) plastic], and the CLX300 and PL1240 [tri(2-ethylhexyl) trimellitate (TEHTM) PVC plastic], it was possible to store PCs for 5 d while preserving platelet function. In spite of these new plastic bags being manufactured without DEHP, we found DEHP and its metabolite mono(2-ethylhexyl) phthalate (MEHP) as contaminants of the supernatant of the PCs stored in these containers. After analyzing the plastic material of each of these containers, we were able to identify the source of the contamination as coming from the plastic materials that were used in the manufacture of the bags. The sterilization process of the PL732 bag was investigated, since it was found that when the plastic of the PL732 bag was analyzed prior to sterilization, no contamination by DEHP was detected; however, whether the PL732 bag was sterilized together with the primary PVC bag or separately, using ethylene oxide, contamination by DEHP was found, suggesting contamination of the sterilization unit by DEHP.     

不同包装和贮藏条件下酸枣仁的质量比较

目的:确定酸枣仁适合的贮藏条件、包装材料和包装方式,为保障酸枣仁质量提供参考。方法:选用同一批酸枣仁样品,分别采取塑料编织袋包装、塑料袋包装、塑料袋真空包装、铝塑复合袋包装、铝塑复合袋真空包装和牛皮淋膜纸袋包装,贮藏在阴凉库(温度≤20℃、相对湿度为45%~75%)和药品稳定性试验箱[温度为(40±2)℃、相对湿度为(75±5)%]中,以性状及水分、黄曲霉毒素、酸枣仁皂苷A、斯皮诺素含量为考察指标,开展为期6个月的阴凉长期稳定性试验和加速稳定性试验研究。结果:6个月阴凉长期稳定性试验结果显示,不同包装条件下酸枣仁样品的性状以及水分、黄曲霉毒素、酸枣仁皂苷A含量均符合2015年版《中国药典》(一部)(后文简称"药典")酸枣仁项下规定;斯皮诺素含量均不符合药典的规定(不低于0.080%),但其中铝塑复合袋真空包装样品中斯皮诺素含量(0.079%)与药典要求接近。6个月加速稳定性试验结果显示,牛皮淋膜纸袋包装、塑料编织袋包装样品发霉严重,塑料袋包装、塑料袋真空包装样品表面颜色变暗,铝塑复合袋包装样品颜色稍变暗,但铝塑复合袋真空包装样品外观基本无变化;塑料编织袋包装、牛皮淋膜纸袋包装样品中水分含量超过了药典要求最高值(9.0%);仅在贮藏2个月时,编织塑料袋包装样品被检出黄曲霉毒素B1含量为8.64μg/kg,超出药典规定;各包装样品中酸枣仁皂苷A含量虽有下降,但均满足药典要求;仅塑料袋真空包装样品中斯皮诺素含量(0.084%)满足药典要求,其次属铝塑复合袋真空包装样品中含量(0.071%)相对较高。结论:酸枣仁以铝塑复合袋真空包装后置于阴凉干燥处为宜。     

聚氯乙烯塑料袋装血液保存液Ⅰ的稳定性考察

目的:考察聚氯乙烯塑料袋装血液保存液Ⅰ在有效期内的稳定性。方法:将3批样品分成2组,一组样品每袋外加聚丙烯复合薄膜小包装袋,另一组不加聚丙烯复合薄膜小包装袋,于相同条件下室温储存,采用留样观察法进行稳定性试验。结果:不加聚丙烯复合薄膜小包装袋的样品储存2y含量升高至(2·95±0·05)%,加聚丙烯复合薄膜小包装袋储存2y含量升高在0·5%以内。结论:聚氯乙烯塑料袋装血液保存液Ⅰ适宜加聚丙烯复合薄膜小包装袋储存。     

静脉输液配制后的微粒数变化及其影响因素探讨

目的：研究静脉输液中添加药物后其不溶性微粒数量的变化情况及其影响因素,为临床合理配制输液提供依据。方法：将添加药物按不同方式组合,加至输液中,按《中华人民共和国药典2010版》中不溶性微粒检查法进行测定。结果：在直立式聚丙烯输液袋中添加4种水针剂进行混合配制后测得的粒径大于或等于10斗m的微粒数平均值超过25个;在聚氯乙烯输液袋和直立式聚丙烯输液袋中添加5种水针剂进行混合配制后测得的粒径大于或等于10μm的微粒数平均值均超过25个,且在直立式聚丙烯输液袋测得的粒径大于或等于25μm的微粒数平均值超过3个;3种粉针剂中,注射用青霉素钠和注射用氨苄西林钠在上述2种输液袋中进行混合配制后测得的粒径大于或等于10μm的微粒数平均值均超过25个,其中注射用青霉素钠在直立式聚丙烯输液袋中所测得的粒径大于或等于25μm微粒数平均值超过3个。结论：输液中添加的药品种类越多,微粒污染越严重;直立式聚丙烯输液袋比聚氯乙烯输液袋更易产生微粒。     

Intravenous (i.v.) fluid administration systems and incompatibility of injection

The safety of the injection therapy has to be secured including that of the injection itself as well as that of the equipment used for injection, i.e. i.v. fluid administration systems. The contamination of insoluble particulate matter ascribed to coating of silicone oil over disposable syringe is being solved by the development of syringe using fluoro-resin laminated rubber. In the case of blood administration set and blood bag system, there are some in which the solvent used for adhesion has been eluted. Further, the relationship between the quality of materials of administration set and the adsorption of drugs has become clear. As regards the plastic container for infusion, insoluble particulate matter and adsorption of drugs have become a problem in connection with the quality of materials used and yet the structure of plastic/rubber combined cap is related to the formation of core, thereby making the improvement. In the case of plastic bag, that made of polyethylene does not adsorb drugs so much and the formation of insoluble particulate matter is a little. For the measures of drug interaction of injection, i.v. fluid administration systems have been applied and the safe and effective method of administration of injection will be established along with the development of I.V. delivery system.     

Effect of two work practice changes on the microbial contamination rates of pharmacy-compounded sterile preparations.

PURPOSE: Using a multiple-step testing medium-risk-level compounding test procedure, the evaluation of two work-practice changes to determine if the changes could effectively reduce the potential for contamination occurrence was conducted. SUMMARY: Along with training and evaluation of aseptic sterile compounding techniques, each individual pharmacist and pharmacy technician at M. D. Anderson Cancer Center must successfully demonstrate aseptic preparation competency annually by performing the complicated multistep aseptic transfers of growth medium with no resulting growth of microorganisms. The multistep aseptic transfers are designed to simulate manual compounding of the most complicated medium-risk-level preparations anticipated as specified in the United States Pharmacopeia's chapter 797. An evaluation of two modest and simple work-practice changes was conducted: The use of bare hands and nonsterile gloves with only initial disinfection with 70% isopropyl alcohol (IPA) during years 1 and 2 (group A) was compared with the use of nonsterile chemotherapy gloves with initial and repeated disinfection with IPA for year 3 (group B) and the use of sterile gloves with initial and repeated disinfection with IPA for year 4 (group C). The process involved multiple discrete manipulations, including reconstitution of dry-growth medium; transfers of growth medium from vials and ampules using syringes, needles, a dispensing pin, and a filter straw; and transfers to an empty plastic i.v. bag. For groups B and C, significant reductions in contaminated samples were found compared with group A. CONCLUSION: The use of protective chemotherapy gloves that were repeatedly disinfected with IPA decreased the contamination rate of pharmacy-compounded sterile preparations.     

Effects of Transportation of IV Bags Containing Protein Formulations Via Hospital Pneumatic Tube System: Particle Characterization by Multiple Methods

In hospitals, often drug products in intravenous (IV) bags are transported via pneumatic tube systems (PTS). The goal of this study was to evaluate the effects of such transportation of protein products on particle formation in polyvinyl chloride (PVC) and polyolefin (PO) IV bags, containing either IV saline or dextrose. We studied intravenous immunoglobulin (IVIG) and a monoclonal antibody (mAb). Particles were quantified with flow imaging, light obscuration and nanoparticle tracking analysis. PTS transportation of IVIG caused large increases in protein particle concentrations, with much greater increases observed in saline than in dextrose. The increases were greater in IV solutions in PO than those in PVC bags. With the mAb, PTS transportation in saline caused increases in protein particle levels in PO bags, but not in PVC bags. Transportation in dextrose did not result in significant increases in mAb particle concentrations in IV bags made of either material. Overall, the results document that the PTS transportation can result in large increases in protein particles and that magnitude of these increases depends the protein itself, the bag material and the IV solution. The main conclusion is that protein products in IV solutions should not be transported in hospital PTS.     

Particulate contamination in plastic ampoules

Plastic ampoules of Water for Injections, JP, and Injection Sodium Chloride, JP, were investigated to determine their particle load. Four batches were studied. The ampoules were twist-opened as they would be in the clinical setting and the total particle load, both inherent and that created in opening, was determined by reading the contents with a HIAC 420 particle counter with a CMB 60 sensor. The total particle content was found to be minimal, easily complying with world L.V.P. standards and the S.V.P. standard of the USP XXI. The number of particles found in these opened plastic ampoules was significantly lower than that found in clinically snap-opened glass ampoules and also slightly lower than that found in laboratory heat-opened glass ampoules. Whilst the plastic ampoule has a restricted application because it is not suitable for all drugs, it is concluded that when they are used as the immediate container for Water for Injections and Injection Sodium Chloride they are highly effective in reducing the particulate contamination generated in opening.