title: Lipid destabilisation in a ternary admixture for paediatric parenteral nutrition due to heparin and trigger factors.
abstract: The preparation of paediatric parenteral nutrition admixtures varies greatly. There is still a clear lack of consensus on many points. These points include the use of organic or inorganic phosphate or calcium salts, preparing binary or ternary mixtures, the type of lipid used, and the addition or suppression of heparin or carnitine, etc. The process must be standardised in order to guarantee that prepared mixtures will be stable. However, there is still no information on how to predict their stability with any degree of precision, particularly for ternary mixtures. For that reason, any change applied may trigger a destabilisation process that places patient safety at risk. We describe a case of a ternary paediatric parenteral nutrition admixture in which creaming was observed. We indicate the factors that gave rise to this phenomenon and the measures taken to avoid it.
authors.affiliation: FEA, Servicio de Farmacia, Hospital General de Elda, Alicante, España. hernandez carpra@gva.es
authors.forename: C
authors.initials: C
authors.lastname: Hernández Prats
authors.forename: M Real
authors.initials: MR
authors.lastname: Panisello
authors.forename: M J
authors.initials: MJ
authors.lastname: Fuentes Bonmatí
authors.forename: C
authors.initials: C
authors.lastname: Torres Chazarra
authors.forename: M I
authors.initials: MI
authors.lastname: Sánchez Casado
mesh_terms: D002118:Calcium / Q000737:chemistry; D002627:Chemistry, Physical; D004339:Drug Compounding / Q000379:methods; D004355:Drug Stability; D004655:Emulsions / Q000737:chemistry; D005260:Female; D006493:Heparin / Q000737:chemistry / Q000494:pharmacology*; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000628:therapy*; D010288:Parenteral Nutrition; D057947:Parenteral Nutrition Solutions / Q000737:chemistry*; D010710:Phosphates / Q000737:chemistry; D010743:Phospholipids / Q000737:chemistry*; D012995:Solubility; D013024:Soybean Oil / Q000737:chemistry*
chemical_list: D004655:Emulsions; D057947:Parenteral Nutrition Solutions; D010710:Phosphates; D010743:Phospholipids; C545823:soybean oil, phospholipid emulsion; D013024:Soybean Oil; D006493:Heparin; D002118:Calcium