Effect of Central Venous Nutrition Infusion, Intravenous Fat Emulsion, and Therapeutic Agents on the Particle Size of Fat Emulsion for Simultaneous Administration of Three Drugs

BACKGROUND: In Japan, therapeutic agents are often administered through the side tube of a central venous line or mixed with a total parenteral nutrition (TPN) infusion. This is expected to result in the mixture of three drugs in the infusion line: the infusion product for TPN, the fat emulsion, and the therapeutic agent. Therefore, we investigated whether various therapeutic agents affect the particle size of the fat emulsion. METHODS: In model of administration A, the TPN infusion formulation was administered through the main tube, and the fat emulsion and therapeutic agents were simultaneously administered through the side tube; 21 therapeutic agents were used. In model of administration B, the TPN infusion formulation mixed with therapeutic agents was administered through the main tube, and the fat emulsion was simultaneously administered through the side tube; 20 therapeutic agents were used. The number of fine particles for each particle size range in the mixed solution was measured over time using a light-shielding automatic fine-particle measuring device. RESULTS: In model A, the number of fine particles in the fat emulsion changed rapidly for five therapeutic agents and slowly for two therapeutic agents. In model B, this change occurred drastically for five therapeutic agents and slowly for one therapeutic agent. CONCLUSIONS: Some therapeutic agents may contribute to fat particle aggregation. Therefore, these therapeutic agents should not be concurrently administered with fat emulsions.