Large-volume parenterals infusions

IV Do not administer undiluted potassium - Potassium preparations must be diluted with suitable large volume parenteral solutions, mixed well and given by slow IV infusion. 

The flrst broad division among parenteral products is between those used for infusions and those used for other forms of administration. Infusions are principally intended for administration in large volumes and are frequently referred to as large volume parenterals (LVPs). With the exception of sterile Water for Injection, LVPs are usually made to be isotonic with blood, for example saline, dextrose, etc. 

This standard for small-volume parenterals was set at 20% of that for large volume parenterals on the unfounded assumption that the average patient receives five small-volume parenterals for each single large-volume infusion. 

Commercially available containers for use with parenteral products include single-dose ampuls that are heat sealed and opened by snapping at the point of least diameter, vials for multidose use, and botdes and pHable bags that are used for large volumes such as needed in intravenous infusions. Container size can vary from 1 mL to 1 L. Generally volumes up to 100 mL are available as ampuls or vials. 

Baxter Healthcare http //www.baxter.com Large and small volume parenterals, premix medications, reconstitution products and accessories, syringe pumps and sets, interlink, administration sets, infusion pumps... 

Ketamine is hepatically metabolized to norketamine, which has reduced CNS activity norketamine is fnrther metabolized and excreted in urine and bile. Ketamine has a large volume of distribution and rapid clearance that make it snitable for continuous infusion withont the drastic lengthening in duration of action seen with thiopental. Protein binding is much lower with ketamine than with the other parenteral anesthetics. 

Patients who can only be fed parenterally over a longer pcricxl of lime need not only calories but also amino acids, electrolytes, trace elements, and vitamins. However, if separate infusions of the different solutions are applied very large volume.s (up to 5 L) must be given. For this reason so-called all-in-one solution.s are aimed at, A popular standard formulation (=2500 kcal. 2600 mL) consists of HKHl-mL ammo acid solution (isoleucinc. leucine, lysine, methionine, phenylalanine. threonine, tryptophane, valine, alanine, arginine, histidine, prolinc. tyro-... 

The advent of parenteral nutrition has opened new avenues for therapy and prevention of malnutrition in these children. However, the technique of parenteral nutrition in burns poses several special problems. Because of the nature of the burned wound, sepsis is a particular hazard. Placement of the catheter is difficult especially when the burns involve the upper trunk and the arms. Whirlpool debridement may compromise sterility at the site of the catheter entrance. On the other hand, infusion of calories through peripheral veins limits the caloric concentration of the infusate and require large volume to meet nutritional needs. There is also an increased incidence of venous thrombosis whenever the dextrose concentration of the infusate exceeds 10%. Some of these complications can partially be prevented by simultaneous infusion of fat emulsion which in addition to their high caloric content also appear to protect peripheral veins from thrombosis. The reported experience with parenteral nutrition in burned children is limited and critical reviews are nonexistent. We have therefore presented the experience with parenteral nutrition of both the Cincinnati and Boston Units of the Shriners Burns Institute. 

Large central veins (e.g. vena jugularis or vena subclavia) An infusion can also be administered subcutaneously. However the volume to be administered is limited to 20-30 mL per 24 h (see Sect. 13.10.3). During extracorporeal circulation procedures such as haemodialysis a parenteral liquid can be administered via ports in the dialysis devices. 

With the aid of the three methods described in Sect. 18.5.4 it can be calculated whether or not a pharmaceutical preparation is iso-osmotic. Hypo-osmolarity can usually be avoided as it can be compensated by the addition of excipients in calculated quantities. Hyper-osmolarity may be inevitable due to dosage reasons, for example when a high dose of an active substance has to be administered in a small volume. The extent to which hyper-osmolarity is tolerated will depend on the route of administration and administration site. The tolerance for parenteral administration, for example, increases in the order subcutaneous < intramuscular < intravenously. This has to do with the fact that of these three routes, the intravenously administered dose spreads most rapidly, and thus dilutes most rapidly in the body and the subcutaneously administered dose most slowly. For the same reason, the tolerance is greater when the solution is injected into a large blood vessel than in a small blood vessel. The tolerance is also determined by the volume infused. In Sects. 

Because most parenteral are made particle free by filtration through a membrane filter just before filling, the container has a relatively large influence on the final level of particles in the product. Anecdotally it appears from results of particle counting studies that infusions in glass usually contain more particles than those in plastic packaging materials. Also small units often contain more particles per unit volume than large ones [8-10]. 

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