Infusion therapy

Continuous intravenous (i.v.) delivery presents another level of complications. Infusion into peripheral veins can become problematic after only a few days and typically requires moving the needle to a new location. Unlike 

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This approach has been used primarily in Japan to treat patients with malignant, inoperable hepatic cancer. Mitomycin C contained in albumin microspheres was administered to patients (122) by percutaneous intraarterial catheterization. Tumor reduction was seen in over 68% of the cases. By contrast, the control group, receiving infusion therapy, had a poorer response. Survival times were also greater for patients receiving the microspheres. 

Phillips I., Meers P.D. DArcy P.F. (1976) Microbiological Flazards of Infusion Therapy. Lancaster MTP Press. 

Garg R, Chaudhuri A, Munschauer F, Dandona P. H3fperglycemia, insulin, and acute ischemic stroke a mechanistic justification for a trial of insulin infusion therapy. Stroke 2006 37 267-273. 

Discharge from the intensive care unit requires maintenance of the preceding parameters in the absence of ongoing IV infusion therapy, mechanical circulatory support, or positive-pressure ventilation. 

Intrathecal administration Because of the possibility of potentially life-threatening CNS depression, cardiovascular collapse, or respiratory failure, physicians must be adequately trained and educated in chronic intrathecal infusion therapy. 

Bode BW, Strange P. Efficacy, safety, and pump compatibility of insulin aspart used in continuous subcutaneous insulin infusion therapy in patients with type 1 diabetes. Diabetes Care 2001 24(l) 69-72. 

Onarheim, H. et al., Marked increase of plasma hyaluronan after major thermal injury and infusion therapy, J. Surg. Res., 50, 259, 1991. 

While animal studies are used for safety assessment prior to administration to humans, preclinical testing may not always predict human effect. For example, continuous-infusion therapy with 260F9 monoclonal antibody-recombinant ricin A chain resulted in severe neurotoxic effects in humans that were not demonstrated in monkey toxicology studies [21], In such cases where suitable animal models are not available for safety testing it is important to consider the application of an appropriate safety factor to provide a margin of safety for protection of humans receiving the initial clinical dose [11,18]. 

Handbook of Infusion Therapy Doyle, R.M., Nale, P., Eds. Springhouse Corporation Springhouse, PA, 1999. 

Andrews, M. Kaplan, H. Weinstock, D.L. Wittig, P.A. Nurses Handbook of Home Infusion Therapy Springhouse HomeCare Springhouse, PA, 1997. 

Metze D, Reimann S, Szepfalusi Z, Bohle B, Kraft D, Luger TA. Persistent pruritus after hydroxyethyl starch infusion therapy a result of long-term storage in cutaneous nerves. Br J Dermatol 1997 136(4) 553-9. 

Maniatis AK, Klingensmith GJ, Slover RH, Mowry CJ, Chase HP. Continuous subcutaneous insulin infusion therapy for children and adolescents an option for routine diabetes care. Pediatrics 2001 107(2) 351-6. 

Vormittag W, Kolaiz G. Chromosomenuntersuchungen vor und nach Infusionstherapie mit Phenylbutazon. [Chromosome studies before and after phenylbutazone infusion therapy.] Arzneimittelforschung 1979 29(8) 1163-8. 

Home infusion therapy has proven to be a safe and effective alternative to patients receiving care in hospital settings. For most patients, receiving treatment in the home (or in an outpatient clinical setting) is preferable to being kept in a hospital. 

Whenever a patient starts on home infusion therapy, a prescription from a qualified physician responsible for the care of the patient is needed. Home nursing services are also generally provided to ensure that the proper patient education and training occurs, and to provide ongoing clinical monitoring of the patient in the home, along with the pharmacist s clinical interventions. 

National Home Infusion Association. Resources for Payers, Physicians Providers Overview of Home Infusion Therapy, www.nhianet.org. 

Triller, D. Hamilton, R. Briceland, L. Waite, N. Audette, C. Furman, C. Home care pharmacy Extending clinical pharmacy services beyond infusion therapy. [In Process Citation]. Am. J. Health Syst.-Pharm, 2000, 57... 

Varon D, Martinowitz U. Continuous infusion therapy in haemophilia. Haemophiha 1998 4 431 35. 

Infusion therapy by drops venally according to the haemodynamic indications (glucose and levulose solutions, Alvesin, alkaline solutions etc.)... 

U.S. Congress, Office of Technology Assessment, Home Drug Infusion Therapy Under Medicare, OTA-H-5IO (Washington, DC U.S. Government Printing Office, May 1992). 

Skin fibroblast or bone marrow transplantation has been used in treating Hurler s and Sanfilippo s syndromes (Dean et al., 1979 Hobbs et al., 1981 Benson, 1982 Navari et al., 1984) as an alternative to enzyme infusion therapy. At 13 months after grafting, the enzymic activity in the leukocytes and serum of the recipients reached heterozygote levels and some patients showed a remarkable clinical improvement (Rappeport and Ginns, 1984 Barranger, 1984). Only a few patients have responded to this treatment, and in others there was no evidence of clinical improvement (Munnich et al., 1982 Dean et al., 1982). Thus more trials of skin fibroblast and bone marrow transplantation are required for judging the usefulness of these procedures. 

For biopharmaceuticals, storage conditions are critical to maintain activity. Normal ICH stability studies are conducted with reference to global climatic zones under standard and accelerated conditions over time periods of up to 5 years. For biopharmaceuticals, this may not be appropriate, and specific coohng conditions (2-8°C, <-20°C) may have to be provided to keep the product intact (see Section 1.4.6). Furthermore, the container and the closure system used for final market presentation (e.g., vial with mbber) must be investigated for interaction potential. Last -but not least - the stability of the reconstituted solution in the case of lyophilisate, or diluted solutions in the case of infusion therapy, must be characterized. 

Absence of gastrointestinal disturbances, usually observed at much lower salicylic acid doses, was again striking. With infusion therapy, the blood picture, kidney and liver functions, blood sugar, serum electrophoresis, electrolyte metabolism, ECG and rheumatic serology were evaluated. No pathological changes or abnormal reactions were found. Nor were there any cerebral, respiratory, or circulatory toxicities observed. 

With magnesium infusion therapy, therapeutic ranges of 1.1 to 2.5 mmol L are achieved in serum. Decreased neuromuscular transmission is observed at 2.5 to 3.5 mmol L , while higher serum magnesium concentrations lead to curare-like effects which can be overcome by calcium infusion. Cardiac arrest occurs at serum concentrations of 10 to 12.5 mmol L. ... 

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