Quality assessment of total parenteral nutrition admixtures by the use of fractional factorial design

Article English OPEN
Mirković, Dušica ; Ibrić, Svetlana ; Antunović, Mirjana (2013)
  • Publisher: Military Health Department, Ministry of Defance, Serbia
  • Journal: Vojnosanitetski pregled (issn: 0042-8450)
  • Related identifiers: doi: 10.2298/VSP1304374M
  • Subject: particle size | parenteral nutrition | quality control | R5-920 | Medicine (General) | electrolytes | fat emulsions, intravenous

Background/Aim. Parenteral nutrition as a specific aspect of providing nutritients still remains a permanent topic of both theoretical and experimental research. Total parenteral nutrition (TPN) admixtures have complex contents making difficult to maintain their stability. The most critical parameter is the diameter of a lipid droplet, i.e. droplet size distribution. It is recommended that droplet size should not be more than 5 􀆬m and that the presence of greater droplets should not exceed the value of 0.05%. Lipid droplets size is affected particularly by electrolyte addition, especially polyvalent cations. There is a danger of the added electrolytes interaction with lipid droplets which leads to their aggregation and negative effects upon the admixtures stability. The aim of this study was to assess the effect of added electrolyte and lipid phase quantity on the admixture stability. Methods. Electrolytes were added to the studied admixture of a defined basic formulation contents in accordance with recommendations from the literature. Droplets size measurements were performed using the method of laser diffraction with a laser particles analyzer. Effects of independent variables were calculated and evaluated using commercial software. Na+, K+, Ca2+ and Mg2+ concentrations, as well as the quantity of fat phase were chosen as studied factors, i.e. independent variables. The system response, or dependent variable was the median of droplets size. Each of the factors was varied at two levels, higher (+1) and lower (-1), according to the 25-2 fractional factorial design. Results. The study suggested the presence of relative uniformity of the results of all the measurements regardless of the quantity of added electrolytes and lipid phase. It was shown that undoubtedly there is the influence of 2-valent cations (calcium and magnesium) upon lipid droplets size, which is in a direct correlation with theoretical assumption. Conclusion. Within a 72-hour testing period there was no significant increase in droplet size, i.e. the studied admixtures remained stable considering droplet size median as the criterion of stability.