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Wozniewski M, Besheer A, Huwyler J, Mahler HC, Levet V, Sediq AS. A Survey on Handling and Administration of Therapeutic Protein Products in German and Swiss Hospitals. J Pharm Sci 2024; 113:735-743. [PMID: 37722452 DOI: 10.1016/j.xphs.2023.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 09/12/2023] [Accepted: 09/12/2023] [Indexed: 09/20/2023]
Abstract
Protein products in hospitals often have to be compounded before administration to the patient. This may comprise reconstitution of lyophilizates, dilution, storage, and transport. However, the operations for compounding and administration in the hospital may lead to changes in product quality and possibly even impact patient safety. We surveyed healthcare practitioners from three clinical units using a questionnaire and open dialogue to document common procedures and their justification and to document differences in handling procedures. The survey covered dose compounding, transportation, storage and administration. One key observation was that drug vial optimization procedures were used for some products, e.g., use of one single-use vial for several patients. This included the use of spikes and needles or closed system transfer devices (CSTDs). Filters or light protection aids were used only when specified by the manufacturer. A further observation was a different handling of the overfill in pre-filled infusion containers, possibly impacting total dose. Lastly, we documented the complexity of infusion administration setups for administration of multiple drugs. In this case, flushing procedures or the placement and use of filters in the setup vary. Our study has revealed important differences in handling and administration practice. We propose that drug developers and hospitals should collaborate to establish unified handling procedures.
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Affiliation(s)
- Maximilian Wozniewski
- Drug Product Services, Lonza AG, Hochbergerstrasse 60G, 4057 Basel, Switzerland; Division of Pharmaceutical Technology, Department of Pharmaceutical Sciences, University of Basel, Klingelbergstrasse 50, 4056 Basel, Switzerland
| | - Ahmed Besheer
- Drug Product Services, Lonza AG, Hochbergerstrasse 60G, 4057 Basel, Switzerland
| | - Jörg Huwyler
- Division of Pharmaceutical Technology, Department of Pharmaceutical Sciences, University of Basel, Klingelbergstrasse 50, 4056 Basel, Switzerland
| | | | - Vincent Levet
- Drug Product Services, Lonza AG, Hochbergerstrasse 60G, 4057 Basel, Switzerland.
| | - Ahmad S Sediq
- Drug Product Services, Lonza AG, Hochbergerstrasse 60G, 4057 Basel, Switzerland
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Zhou M, Dong S, Zhang J, Liu Y, Zhang L, Xu J, Yang Y, He Y, Wu K, Yuan Y, Lin W, Bian W, Li J, Chen C, Xue Y, Tao T, Kang Y, Sun L, Yuan L, Xu C. Effects of the low-speed continuous infusion catheter technique on double-lumen central venous catheters: A randomized controlled trial. Int J Nurs Stud 2024; 151:104676. [PMID: 38241817 DOI: 10.1016/j.ijnurstu.2023.104676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 12/12/2023] [Accepted: 12/13/2023] [Indexed: 01/21/2024]
Abstract
BACKGROUND Central venous catheters are widely used in clinical practice, and the incidence of central venous catheter occlusion is between 25 % and 38 %. The turbulence caused by the pulsatile flushing technique is harmful to the vascular endothelium and may lead to phlebitis. The low-speed continuous infusion catheter technique is a new type of continuous infusion that ensures that the catheter is always in a keep-vein-open state by continuous low-speed flushing; hence, avoiding the problem of catheter occlusion. OBJECTIVE To investigate the effectiveness of the low-speed continuous infusion catheter technique and the routine care of double-lumen central venous catheters. DESIGN This was a prospective, randomized, controlled, open-label trial. SETTING Patients were recruited from 14 medical institutions in China between February and June 2023. PARTICIPANTS In total, 251 patients were recruited, with 125 in the intervention group and 126 in the control group. METHODS Patients who used double-lumen central venous catheters for infusion treatment were selected, and those who met the sampling criteria were randomly divided into intervention and control groups using the random envelope method. The intervention group used the low-speed continuous infusion catheter technique to maintain catheter patency, whereas the control group used routine care with a trial period of 7 days. The primary outcome was the occlusion rate. The secondary outcomes included nursing satisfaction and complication rates of the two groups. RESULTS After 7 days, the rate of catheter occlusion was 28.0 % (35/125, 95 % confidence interval (CI):0.203, 0.367) in the intervention group and 53.97 % (68/126, 95 % CI: 0.449-0.629) in the control group, with a statistically significant difference (χ2 = 17.488, p < 0.001); at 3 days of intervention, the rate of catheter blockage was 8.0 % (10/125, 95 % CI: 0.039-0.142) in the intervention group and 23.8 % (30/126, 0.167-0.322) in the control group, with a statistically significant difference (χ2 = 11.707, p < 0.001). Nurse satisfaction was significantly higher in the intervention group (115/125, 92.0 %, 95 % CI: 0.858-0.961) than in the control group (104/126, 82.54 %, 95 % CI: 0.748-0.887) (χ2 = 5.049, p = 0.025). There were no statistically significant complication rates in either group (p = 0.622). CONCLUSION The low-speed continuous infusion catheter technique helps maintain catheter patency, improves nurse satisfaction, and provides a high level of safety. REGISTRATION Chinese Clinical Trial Registry (ChiCTR2200064007, www.chictr.org.cn). The first recruitment was conducted in February. https://www.chictr.org.cn/showproj.html?proj=177311.
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Affiliation(s)
- Mian Zhou
- Department of Oncology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Shan Dong
- Department of Oncology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Jinghui Zhang
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Yuping Liu
- The Affiliated Hospital of Xuzhou Medical University, China
| | - Liuliu Zhang
- Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, China
| | - Junxia Xu
- The First Affiliated Hospital of USTC, China
| | - Ying Yang
- Huai'an First People's Hospital, China
| | - Yulan He
- Hunan Provincial People's Hospital (the First Affiliated Hospital of Hunan Normal University), China
| | | | - Yuan Yuan
- Affiliated Hospital of Yangzhou University, China
| | - Wenqin Lin
- Yizheng Hospital of Nanjing Drum Tower Hospital Group, China
| | - Wenxia Bian
- The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, China
| | - Juan Li
- Huai'an Second People's Hospital, China
| | - Chunli Chen
- The Second People's Hospital of Hefei, China
| | - Youhua Xue
- Department of Interventional and Vascular Surgery, Zhongda Hospital affiliated to Southeast University, China
| | - Tingting Tao
- Department of General Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Yubiao Kang
- School of Nursing, Nanjing University of Chinese Medicine, 138 Xianlin Avenue, Qixia District, Nanjing, Jiangsu Province 210023, China
| | - Lulu Sun
- Department of Oncology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Ling Yuan
- Department of Oncology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China; School of Nursing, Nanjing University of Chinese Medicine, 138 Xianlin Avenue, Qixia District, Nanjing, Jiangsu Province 210023, China..
| | - Cuirong Xu
- Department of Nursing, Zhongda Hospital Southeast University, Nanjing, China.
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