Pharmacological properties of the drug Kabiven central
Pharmacodynamics. The pharmacological properties of the drug are determined by its composition. Fat emulsion (Intralipid 20%) The fat emulsion included in Kabiven Central is a source of long-chain fatty acids (in particular essential fatty acids), which are used in the body as a source of energy and for the construction of cell membranes. Intralipid in recommended doses does not affect hemodynamics. There were no clinically significant cases of deterioration in pulmonary function when the recommended infusion rate was observed. Cases of increased levels of liver enzymes in the blood have been observed in rare cases. After the end of parenteral nutrition, enzyme levels returned to initial values. Similar changes are observed during parenteral nutrition, which does not include a fat emulsion. Amino acids and electrolytes (Vamin 18 Novum) Amino acids are an integral part of proteins in regular food. They are used in the body for protein synthesis and partly in the process of gluconeogenesis. Infusion of amino acids leads to an increase in the level of metabolism and, accordingly, to an increase in heat production in the body. Glucose (glucose solution 19%) Glucose has the same pharmacodynamic properties as glucose, which takes part in normal metabolism. Pharmacokinetics Fat emulsion (Intralipid 20%) Intralipid is similar in its biological properties to endogenous chylomicrons. Unlike chylomicrons, Intralipid does not contain cholesterol esters or apolipoproteins. The phospholipid content is significantly higher in Intralipid than in chylomicrons. Intralipid is cleared from the bloodstream in the same way as chylomicrons. Exogenous fat particles are mainly hydrolyzed in the blood and taken up by LDL receptors in the liver and peripheral tissues. The rate of elimination is determined by the composition of the fat particles, the clinical and nutritional status of the patient, and the rate of infusion. The maximum fasting clearance of Intralipid is equivalent to 3.8±1.5 g triglycerides/1 kg body weight/day. The rate of excretion and oxidation of fat emulsion accelerates during sepsis, as well as after injuries, and, on the contrary, slows down during renal failure and hypertriglyceridemia. Amino acids and electrolytes (Vamin 18 Novum) The pharmacokinetic characteristics of amino acids and electrolytes that are administered intravenously are the same as when they are supplied with food. However, amino acids from food proteins first enter the hepatic portal vein and only then enter the systemic circulation, whereas amino acids administered intravenously enter directly into the systemic circulation. Glucose (glucose solution 19%) The pharmacokinetic characteristics of glucose, which is administered by intravenous infusion, are the same as when taken with food.
Kabiven central, 4 pcs., 2053 ml, emulsion for infusion
IV,
drip.
Only in the central veins. The infusion can be continued for as long as the patient’s clinical condition requires, based on the daily need for glucose, lipids and amino acids.
The dosage and rate of infusion are determined by the patient's ability to eliminate lipids and metabolize glucose.
Kabiven® central is available in bags of 4 sizes (for patients with normal, moderately increased or decreased need for nutrients). Total parenteral nutrition may require supplementation with vitamins, electrolytes, and micronutrients.
The dose should be selected individually and when choosing the size of the bag, take into account the patient’s condition, body weight and nutritional needs.
In obese patients, the dose should be set based on ideal body weight.
In patients with moderate to severe catabolic stress with or without malnutrition, amino acid requirements are 1–2 g/kg/day, corresponding to a nitrogen requirement of 0.15–0.3 g/kg/day. This corresponds to 27–40 ml/kg/day of the drug Kabiven® central.
In patients without severe catabolic stress, the amino acid requirement is 0.7–1.3 g/kg/day, which corresponds to a nitrogen requirement of 0.1–0.2 g/kg/day. This corresponds to 19–38 ml/kg/day of the drug Kabiven® central.
The maximum daily dose for adults is 40 ml/kg/day. This corresponds to one bag (largest size 2566 ml) for a 64 kg patient and provides 1.3 g amino acids/kg/day (0.21 g/kg/day nitrogen), 31 kcal/kg/day non-protein energy, 3 .9 g/kg/day glucose and 1.6 g/kg/day lipids. The maximum daily dose depends on the clinical condition of the patient and may vary.
For children, dosage is determined by the patient's body's ability to metabolize individual nutrients. Infusion for children (from 2 to 10 years) should begin with low doses (14–28 ml/kg/day), then the dose should be increased by 10–15 ml/kg/day, to a maximum of 40 ml/kg/day. In children over 10 years of age, the same doses are used as in adults.
Infusion rate.
The infusion rate of the drug Kabiven® central should not exceed 2.6 ml/kg/h, which corresponds to an infusion rate of glucose 0.25 g/kg/h, amino acids 0.09 g/kg/h and lipids 0.13 g/kg/ h. The recommended duration of infusion of Kabiven® central is 12–24 hours.
Shelf life after mixing with additives
Once the fixatives are opened and the three solutions are mixed, compatible additives can be added to the mixture through the additive injection port.
Once the fixatives are released, the chemical and physical stability of the mixed contents of the three chambers is maintained for 24 hours at 25°C.
To ensure microbiological safety, the mixture should be used immediately after the addition of additives. If the mixture is not used immediately, then, provided asepsis is observed when introducing additives, the finished mixture can be stored for up to 6 days at 2–8 °C, after which the mixture should be used within 24 hours.
Recommendations for preparing the Biofin container for use
Diagram of the Biofin container
(see Fig. 1).
1 - cut on the outer package; 2 - holder; 3 — hole for hanging the package; 4 - dividing partition; 5 — blind port (not used); 6 - port for introducing additives; 7 — port for infusion system; 8 — oxygen absorber (in the outer package).
1. Removing an external package
(see Fig. 2, 3).
Place the container on a horizontal surface. Tear the outer bag at the cut site by pulling along the edge (Fig. 2).
Remove the outer bag and throw it away along with the oxygen absorber (Fig. 3).
2. Mixing
(See Fig. 4–7).
Place the three-chamber bag on a horizontal surface. Roll the bag from the corner on the holder side diagonally towards the blind port (Fig. 4).
Then, holding the folded part with one hand and maintaining constant pressure inside the bag, apply force (press) with the other hand on the bag until the vertical partitions open (Fig. 5).
Vertical partitions open due to the pressure created by the contents of the package! There is no need to open the horizontal partition - the contents of the chambers are easily mixed after opening only the vertical partitions (Fig. 6).
Mix the contents of the chambers by turning the bag 2-3 times (Fig. 7). Note: The dividers can be opened before being removed from the outer bag, at which point the outer bag can be removed.
3. Connecting the infusion system
(See Fig. 8–11).
If it is necessary to introduce additives (with confirmed compatibility, for example, special preparations of vitamins, microelements, Dipeptiven), remove (break off) the cap with the arrow from the white port immediately before introducing the additives (Fig. 8).
While holding the base of the additive injection port, insert the needle completely through the center of the membrane and inject the confirmed compatible additive (Figure 9). Before adding another additive, thoroughly mix the contents by turning the bag over several times.
Connecting the infusion system: immediately before inserting the needle, remove the cap from the blue port (Fig. 10).
Holding the bag with the port for the infusion system facing up, insert the needle through the membrane, turning and pushing it if necessary (Fig. 11). Use a non-vented infusion system or shut off the air supply to a ventilated system. Note: The inside of the ports is sterile.
4. Hanging on the infusion stand
(see Fig. 12).
Hang the bag on the rack using the hole on the holder (Fig. 12).
Use of the drug Kabiven central
For IV infusions. Intended for injection into central veins only. To reduce the risk of developing thrombophlebitis when administered into peripheral veins, it is recommended to change the catheter installation site once a day. Fat excretion capacity and glucose metabolism must be taken into account when dosing and determining the infusion rate. The dose must be selected individually and the size of the drug container must be selected taking into account the patient's condition, body weight and nutritional needs. The nitrogen requirement for protein synthesis depends on the patient's condition (nutritional status, level of catabolic stress). Under normal nutritional status, the patient needs 0.10–0.15 g nitrogen/1 kg body weight/day. For patients with moderate to severe catabolic syndrome with or without malnutrition, the nitrogen requirement is 0.15–0.30 g nitrogen/1 kg body weight/day (1.0–2.0 g amino acids/1 kg body weight/ days). The introduction of such an amount of amino acids also requires the introduction of 2.0–6.0 g of glucose and 1.0–2.0 g of fat. The total energy requirement depends on the patient's condition and is approximately 25–35 kcal/1 kg of body weight/day. For overweight patients, the dose should be calculated based on ideal body weight. Kabiven Central is available in containers of 4 different volumes, which allows the drug to be used for use in patients with high, medium or low need for parenteral nutrition. When carrying out parenteral nutrition, there may be a need to add vitamins, individual electrolytes or microelements. Use in adults : 19–38 ml of Kabiven Central per 1 kg of body weight/day (corresponding to 0.1–0.2 g of nitrogen/1 kg of body weight/day, or 0.7–1.3 g of amino acids/1 kg of body weight body weight/day. The energy value of this corresponds to 25–35 kcal/1 kg body weight/day). For a patient weighing 70 kg, this corresponds to 1330–2660 ml of Kabiven Central per day. Use in children aged 2–10 years Infusion in children aged 2–10 years should be started with low doses: 12.5–25 ml of Kabiven Central per 1 kg of body weight/day (corresponding to 0.49–0.98 g fat/1 kg body weight/day, 0.41–0.83 g amino acids/1 kg body weight/day and 1.2–1.4 g glucose/1 kg body weight/day), increase dosage by 10–15 ml/1 kg every other day until the maximum dose of 40 ml of Kabiven Central per 1 kg of body weight/day is reached. Children aged 10 years and older Dosage of Kabiven Central is the same as for adults. Children under 2 years of age The use of Kabiven Central in children under 2 years of age is not recommended. Infusion rate The maximum infusion rate for glucose is 0.25 g/1 kg body weight/hour. The maximum rate of amino acid administration should not exceed 0.1 g/1 kg body weight/hour. The maximum infusion rate for fats is 0.15 g/1 kg body weight/hour. The infusion rate of the drug should not exceed 2.6 ml/1 kg body weight/h, which corresponds to a dose of glucose, amino acids and lipids of 0.25 g/1 kg body weight/h, 0.09 g/1 kg body weight/h, and 0.13 g/1 kg body weight/h, respectively. The recommended duration of drug infusion is 12–24 hours. The maximum daily dose is 40 ml/1 kg body weight/day, this corresponds to one container (maximum capacity) for patients weighing 64 kg and provides 1.3 g of amino acids/1 kg body weight/day (0.21 g nitrogen/1 kg body weight/day), 31 kcal/1 kg body weight/day non-protein energy (3.9 g glucose/1 kg body weight/day and 1.6 g lipids/ 1 kg body weight/day). Instructions for using the 3-chamber container Remove the outer bag by tearing it at the cut and pulling it along the bag. With the thumbs and forefingers of both hands, firmly grasp the side walls of the bag above the middle of the latch that separates chambers 1 and 2. Pull the walls of the bag to the sides and completely open the latch. Open the lock between chambers 2 and 3 in the same way. Mix the contents by turning the bag over several times. If it is necessary to introduce an additive (with known compatibility, for example, vitamin preparations, microelements), wipe the inlet membrane with an antiseptic. Place the package on the table; Holding the base of the inlet, insert the needle completely through the center of the membrane and inject the additive (of known compatibility). Before adding the second additive, thoroughly mix the contents by turning the bag over several times. Remove the cap from the infusion system needle by grasping the ring with your thumb and forefinger and pulling the ring up. Use an infusion system without air access or block air access in a system that does have air access. Place the bag on a flat surface. Holding the bag with the inlet facing up, insert the needle completely through the membrane. To securely fasten the needle, it must be inserted completely. Hang the bag on the stand and follow the instructions for the infusion set and infusion pump. The second way to open the latches is to place the bag on a flat surface and roll it up from the handle side until the latches open. Mix the contents by turning the bag several times. Note: separate administration of components from individual chambers of Kabiven Central is technically impossible (with the exception of Intralipid), although each component of the drug (glucose solution, Vamin and Intralipid) can be used in the form of separate drugs.
Kabiwen
Intravenous, drip, only into the central veins. The infusion can be continued for as long as the patient’s clinical condition requires, based on the daily requirement for dextrose, lipids and amino acids.
The dosage and rate of infusion are determined by the patient's ability to eliminate lipids and metabolize dextrose.
Kabiven central is available in bags of four sizes, intended for patients with normal, moderately increased or decreased nutritional needs. Total parenteral nutrition may require supplementation with vitamins, electrolytes, and micronutrients.
The dose should be individualized, and the patient's condition, body weight, and nutritional requirements should be taken into account when choosing bag size.
In obese patients, the dose should be set based on ideal body weight.
In patients with moderate to severe catabolic stress with or without malnutrition, the amino acid requirement is 1.0-2.0 g/kg/day, which is equal to the nitrogen requirement of 0.15-0.30 g/kg/day.
In patients without severe catabolic stress, the amino acid requirement is 0.7-1.3 g/kg/day, which is equal to the nitrogen requirement of 0.10-0.20 g/kg/day. This corresponds to 19-38 ml of Kabiven central per 1 kg of body weight per day.
Maximum daily dose
Adults 40 ml/kg/day. This is equal to one bag (largest size - 2566 ml) for a patient weighing 64 kg and provides 1.3 g amino acids/kg/day (0.21 g nitrogen/kg/day), 31 kcal/kg/day non-protein energy, 3 .9 g glucose/kg/day and 1.6 g fat/kg/day.
The maximum daily dose depends on the clinical condition of the patient and may vary.
Children Dosage is determined by the patient's ability to metabolize individual nutrients.
Infusion for children (from 2 to 10 years) should begin with low doses (14-28 ml/kg/day; the dose should be increased by 10-15 ml/kg/day, to a maximum of 40 ml/kg/day.
In children over 10 years of age, the same doses can be used as in adults.
Kabiven central is intended primarily for patients over 2 years of age. In children under 2 years of age, Kabiven central can be used in the absence of special adapted amino acid solutions containing taurine.
Infusion rate: The maximum dextrose infusion rate is 0.25 g/kg/hour.
The dose of amino acids should not exceed 0.1 g/kg/hour.
Lipid intake should be no more than 0.15 g/kg/hour.
The infusion rate of Kabiven central should not exceed 2.6 ml/kg/hour, which corresponds to an infusion rate of glucose 0.25 g/kg/hour, amino acids 0.09 g/kg/hour and fats 0.13 g/kg/hour. The recommended duration of infusion of Kabiven central is 12-24 hours.
The administration of Kabiven central can be continued for as long as the patient’s clinical condition requires, based on daily needs.
Contraindications to the use of Kabiven central
Hypersensitivity to egg and soy proteins or to any of the components of the drug; severe hyperlipidemia; severe liver failure; severe disorders of the blood coagulation system; hereditary disorders of amino acid metabolism; severe renal failure in patients who do not undergo hemodialysis or hemofiltration; acute phase of shock; hyperglycemia, requiring insulin administration in doses of 6 units/hour; pathologically increased concentration in the blood plasma of any of the electrolytes included in the drug; the presence of general contraindications to infusion therapy (pulmonary edema, overhydration, heart failure, hypotonic dehydration); hemophagocytic syndrome; unstable condition (in particular, condition after injury, decompensated diabetes mellitus, myocardial infarction in the acute phase, decompensated metabolic acidosis, severe sepsis and hyperosmolar coma); age up to 2 years.
Kabiven peripheral emulsion. d/inf. 1920 ml No. 4
When using the drug, the ability to remove lipids should be monitored by measuring the level of TG in the blood plasma 5-6 hours after the last intake of fats.
The concentration of TG in the blood plasma during infusion should not exceed 3 mmol/l.
Fat overload syndrome may occur at the recommended infusion rate if the patient's clinical condition changes dramatically and severe renal or hepatic failure develops.
The volume of drug administered should be carefully calculated and adjusted according to the fluid balance and nutritional status of the patient. Each container is intended for single use.
Severe electrolyte and fluid imbalances should be corrected before infusion.
Monitoring of the patient is required at the beginning of the infusion. Because any central venous infusion carries an increased risk of infection, strict asepsis must be observed during catheter insertion or manipulation to avoid infection.
It is necessary to regularly monitor the concentrations of glucose and electrolytes in the blood plasma, as well as plasma osmolarity, water balance, acid-rich acid and liver enzyme activity.
With long-term administration of lipids, the cellular composition of the blood and blood coagulation parameters should be monitored.
In patients with renal failure, phosphate and potassium balance should be carefully monitored to avoid the development of hyperphosphatemia and hyperkalemia.
The amount of additional electrolytes should be determined by regularly monitoring their concentration, taking into account the clinical condition of the patient.
This preparation does not contain vitamins and microelements. To replenish them, it is recommended to use Vitalipid N for adults or Vitalipid N for children, Soluvit N, Addamel N.
If any symptoms or signs of allergic reactions occur, the infusion should be stopped immediately.
The presence of lipids in Kabiven peripheral may alter the results of some laboratory tests (eg, bilirubin concentration, LDH activity, hemoglobin oxygen saturation) if the blood sample was obtained before sufficient clearance of lipids from the bloodstream. In most patients, injected lipids are eliminated within 5-6 hours.
IV administration of amino acids may be accompanied by increased renal excretion of trace elements, especially zinc. Patients requiring long-term IV nutrition may require additional micronutrient supplementation.
In severely malnourished patients, initiation of parenteral nutrition may cause a shift in fluid balance, leading to pulmonary edema and congestive heart failure. In addition, within 24-48 hours, a decrease in the concentrations of potassium, phosphorus, magnesium and water-soluble vitamins in the blood plasma may be observed. It is recommended to initiate parenteral nutrition slowly with careful monitoring and appropriate adjustment of fluids, electrolytes, vitamins and minerals.
Kabiven peripheral should not be administered through the same catheter at the same time as blood or blood products.
Patients with hyperglycemia may require insulin administration. A venous catheter through which total parenteral nutrition is administered is not recommended for use for intravenous administration of other solutions and drugs.
Any remains from an open container must be destroyed.
Use in pediatrics
Kabiven peripheral is intended primarily for patients over 2 years of age. In children under 2 years of age, Kabiven peripheral can be used only for health reasons in the absence of special adapted amino acid solutions containing taurine (Aminoven infant). Premature and low birth weight babies may have impaired fat metabolism. TG concentrations should be carefully monitored.
Special instructions for the use of the drug Kabiven central
No special studies have been conducted on the safety of the drug during pregnancy and lactation. Before prescribing Kabiven Central, pregnant women and women during breastfeeding should assess the risk/benefit ratio. The ability to influence reaction speed when driving vehicles and working with other complex mechanisms has not been studied; The drug is intended for use only in a hospital setting. When using the drug, you should monitor the process of lipid removal by determining the level of TG in the blood plasma 5–6 hours after the last use of fats. The concentration of TG in the blood plasma during infusion should not exceed 3 mmol/l. The volume of the container for administration should be selected individually. Each package is intended for one-time use. It is necessary to accurately calculate the volume of drug to be administered, which should be adjusted taking into account the fluid balance and nutritional status of the patient. Severe electrolyte and fluid imbalances (eg, abnormally high or low serum electrolyte levels) should be corrected before infusion. At the beginning of the infusion, the patient's condition should be monitored. The infusion should be stopped if the patient's condition worsens. Because any central venous infusion carries an increased risk of infection, asepsis should be used during catheter insertion or manipulation to avoid infection. Kabiven Central should be used with caution in patients with reduced lipid metabolism, which is observed in renal failure, decompensated diabetes mellitus, pancreatitis, impaired liver function, hypofunction of the thyroid gland (with hypertriglyceridemia), and sepsis. The use of Kabiven Central in such patients should be carried out under mandatory constant monitoring of the level of TG concentration in the blood serum. It is necessary to regularly monitor the concentration of glucose and electrolytes in the blood plasma, as well as plasma osmolarity, water balance, COR and liver enzyme activity. With prolonged administration of lipids, it is necessary to monitor the cellular composition of the blood and blood coagulation parameters. In patients with renal failure, the balance of phosphate and potassium should be monitored to avoid the development of hyperphosphatemia and hyperkalemia. The amount of additional electrolytes should be determined by regularly monitoring their concentration, taking into account the clinical condition of the patient. This preparation does not contain vitamins and microelements. The addition of microelements and vitamins is allowed. When adding vitamins, the same calculations are used as in pediatrics. Parenteral infusion should be used with caution in patients with metabolic acidosis (eg lactic acidosis), since an increase in serum osmolarity requires rehydration. Kabiven Central is used with caution in patients with a tendency to retain electrolytes. If any symptoms or signs of allergic reactions occur, the infusion should be stopped immediately. The presence of lipids in the drug may alter the results of some laboratory tests (for example, bilirubin concentration, LDH activity, blood oxygenation level, hemoglobin level) if the blood sample was taken before sufficient removal of lipids from the bloodstream. In most patients, injected lipids are eliminated within 5–6 hours. IV administration of amino acids may be accompanied by increased renal excretion of trace elements, especially zinc. Patients requiring long-term intravenous nutrition may require additional micronutrients. In malnourished patients, the initiation of parenteral nutrition can cause fluid imbalance, which leads to the development of pulmonary edema and congestive heart failure. In addition, over a period of 24–48 hours, a decrease in the concentrations of potassium, phosphorus, magnesium and water-soluble vitamins in the blood plasma may be observed. It is recommended to initiate parenteral nutrition slowly, subject to strict monitoring and appropriate adjustment of the amount of fluid, electrolytes, vitamins and trace elements. Kabiven Central should not be administered through the same catheter simultaneously with whole blood or its preparations. Patients with hyperglycemia may require insulin administration. Kabiven Central solutions have an osmolarity of 1060 mOsmol/l and therefore are not intended for intravenous administration through peripheral veins in both adults and children due to the possibility of developing thrombophlebitis.
Kabiven® central
Intravenous drip, only into the central veins.
The infusion can be continued for as long as the patient’s clinical condition requires, based on the daily need for glucose, lipids and amino acids.
The dosage and rate of infusion are determined by the patient's ability to eliminate lipids and metabolize glucose.
Kabiven® central is available in four sizes of bags intended for patients with normal, moderately increased or decreased nutritional needs. Total parenteral nutrition may require supplementation with vitamins, electrolytes, and micronutrients.
The dose should be individualized, and when choosing the volume of the bag, the patient's condition, body weight and nutritional requirements should be taken into account.
In obese patients
The dose should be set based on ideal body weight.
In patients with moderate to severe catabolic stress with or without malnutrition
the need for amino acids is 1.0-2.0 g/kg/day, which is equal to the need for nitrogen 0.15-0.30 g/kg/day. This corresponds to 27-40 ml of Kabiven central® per 1 kg of body weight per day.
In patients without severe catabolic stress
and the need for amino acids is 0.7-1.3 g/kg/day, which is equal to the need for nitrogen 0.10-0.20 g/kg/day. This corresponds to 19-38 ml of Kabiven central® per 1 kg of body weight per day.
Maximum daily dose
Adults
40 ml/kg/day. This is equal to one bag (largest size - 2566 ml) for a patient weighing 64 kg and provides 1.3 g amino acids/kg/day (0.21 g nitrogen/kg/day), 31 kcal/kg/day non-protein energy, 3 .9 g glucose/kg/day and 1.6 g fat/kg/day. .
The maximum daily dose depends on the clinical condition of the patient and may vary.
Children
Dosage is determined by the patient's ability to metabolize individual nutrients.
Infusion for children (from 2 to 10 years) should begin with low doses (14-28 ml/kg/day, the dose should be increased by 10-15 ml/kg/day, maximum dose 40 ml/kg/day).
In children over 10 years of age, the same doses can be used as in adults.
Infusion rate:
The infusion rate of Kabiven® central should not exceed 2.6 ml/kg/h, which corresponds to an infusion rate of glucose 0.25 g/kg/h, amino acids 0.09 g/kg/h and fats 0.13 g/kg/h .
The recommended duration of infusion of Kabiven® central is 12-24 hours.
Instructions for using a three-chamber bag
-Remove the outer bag by tearing it at the cut and pulling it along the bag.
-Using the thumbs and forefingers of both hands, firmly grasp the side walls of the bag above the middle of the latch separating chambers 1 and 2. Pull the walls of the bag to the sides and open the latch completely.
-In the same way, open the lock between chambers 2 and 3. Mix the contents by turning the bag over several times.
-If it is necessary to introduce an additive (with known compatibility, for example, preparations of vitamins, microelements), wipe the membrane of the inlet with an antiseptic.
-Put the bag on the table, holding the base of the inlet, insert the needle completely through the center of the membrane and inject the additive (of known compatibility). Before adding another additive, mix the contents thoroughly by inverting the bag several times.
-Remove the cap from the infusion set needle by grasping the ring with your thumb and forefinger and pulling the ring up. Use an infusion system without air access or turn off the air supply on a system with air access.
-Place the bag on a flat surface. Holding the bag with the outlet facing up, insert the needle all the way through the membrane, twisting and pushing as necessary. To securely fasten the needle, it must be inserted completely.
-Hang the bag on the stand and follow the instructions for the infusion set and infusion pump.
-Another way to open the latches: Place the bag on a flat surface and roll it up from the handle side until the latches open. Mix the contents thoroughly by turning the bag over several times.
Note
: separate administration of components from individual chambers of Kabiven® central is technically impossible (with the exception of Intralipid), although each component of Kabiven® central: Vamin, Intralipid and glucose solution can be used as separate preparations.
Interactions of the drug Kabiven central
After opening the clamps and mixing the 3 solutions, compatible additives can be added to the mixture through the inlet. Heparin in therapeutic doses causes the release of lipoprotein lipase into the bloodstream, which can lead first to increased lipolysis in the blood plasma, and then to a decrease in TG clearance. Insulin can also affect lipase activity, but there is no data regarding the adverse effect of this fact on the therapeutic effectiveness of the drug. Vitamin K1, contained in soybean oil, is an antagonist of coumarin derivatives, so it is recommended to carefully monitor blood clotting in patients receiving these drugs. Adding any medications or other solutions to Kabiven Central is possible only if their compatibility is known.
Kabiven central, emulsion for infusion, 2053 ml, 1 pc.
IV,
drip.
Only in the central veins. The infusion can be continued for as long as the patient’s clinical condition requires, based on the daily need for glucose, lipids and amino acids.
The dosage and rate of infusion are determined by the patient's ability to eliminate lipids and metabolize glucose.
Kabiven® central is available in bags of 4 sizes (for patients with normal, moderately increased or decreased need for nutrients). Total parenteral nutrition may require supplementation with vitamins, electrolytes, and micronutrients.
The dose should be selected individually and when choosing the size of the bag, take into account the patient’s condition, body weight and nutritional needs.
In obese patients, the dose should be set based on ideal body weight.
In patients with moderate to severe catabolic stress with or without malnutrition, amino acid requirements are 1–2 g/kg/day, corresponding to a nitrogen requirement of 0.15–0.3 g/kg/day. This corresponds to 27–40 ml/kg/day of the drug Kabiven® central.
In patients without severe catabolic stress, the amino acid requirement is 0.7–1.3 g/kg/day, which corresponds to a nitrogen requirement of 0.1–0.2 g/kg/day. This corresponds to 19–38 ml/kg/day of the drug Kabiven® central.
The maximum daily dose for adults is 40 ml/kg/day. This corresponds to one bag (largest size 2566 ml) for a 64 kg patient and provides 1.3 g amino acids/kg/day (0.21 g/kg/day nitrogen), 31 kcal/kg/day non-protein energy, 3 .9 g/kg/day glucose and 1.6 g/kg/day lipids. The maximum daily dose depends on the clinical condition of the patient and may vary.
For children, dosage is determined by the patient's body's ability to metabolize individual nutrients. Infusion for children (from 2 to 10 years) should begin with low doses (14–28 ml/kg/day), then the dose should be increased by 10–15 ml/kg/day, to a maximum of 40 ml/kg/day. In children over 10 years of age, the same doses are used as in adults.
Infusion rate.
The infusion rate of the drug Kabiven® central should not exceed 2.6 ml/kg/h, which corresponds to an infusion rate of glucose 0.25 g/kg/h, amino acids 0.09 g/kg/h and lipids 0.13 g/kg/ h. The recommended duration of infusion of Kabiven® central is 12–24 hours.
Shelf life after mixing with additives
Once the fixatives are opened and the three solutions are mixed, compatible additives can be added to the mixture through the additive injection port.
Once the fixatives are released, the chemical and physical stability of the mixed contents of the three chambers is maintained for 24 hours at 25°C.
To ensure microbiological safety, the mixture should be used immediately after the addition of additives. If the mixture is not used immediately, then, provided asepsis is observed when introducing additives, the finished mixture can be stored for up to 6 days at 2–8 °C, after which the mixture should be used within 24 hours.
Recommendations for preparing the Biofin container for use
Diagram of the Biofin container
(see Fig. 1).
1 - cut on the outer package; 2 - holder; 3 — hole for hanging the package; 4 - dividing partition; 5 — blind port (not used); 6 - port for introducing additives; 7 — port for infusion system; 8 — oxygen absorber (in the outer package).
1. Removing an external package
(see Fig. 2, 3).
Place the container on a horizontal surface. Tear the outer bag at the cut site by pulling along the edge (Fig. 2).
Remove the outer bag and throw it away along with the oxygen absorber (Fig. 3).
2. Mixing
(See Fig. 4–7).
Place the three-chamber bag on a horizontal surface. Roll the bag from the corner on the holder side diagonally towards the blind port (Fig. 4).
Then, holding the folded part with one hand and maintaining constant pressure inside the bag, apply force (press) with the other hand on the bag until the vertical partitions open (Fig. 5).
Vertical partitions open due to the pressure created by the contents of the package! There is no need to open the horizontal partition - the contents of the chambers are easily mixed after opening only the vertical partitions (Fig. 6).
Mix the contents of the chambers by turning the bag 2-3 times (Fig. 7). Note: The dividers can be opened before being removed from the outer bag, at which point the outer bag can be removed.
3. Connecting the infusion system
(See Fig. 8–11).
If it is necessary to introduce additives (with confirmed compatibility, for example, special preparations of vitamins, microelements, Dipeptiven), remove (break off) the cap with the arrow from the white port immediately before introducing the additives (Fig. 8).
While holding the base of the additive injection port, insert the needle completely through the center of the membrane and inject the confirmed compatible additive (Figure 9). Before adding another additive, thoroughly mix the contents by turning the bag over several times.
Connecting the infusion system: immediately before inserting the needle, remove the cap from the blue port (Fig. 10).
Holding the bag with the port for the infusion system facing up, insert the needle through the membrane, turning and pushing it if necessary (Fig. 11). Use a non-vented infusion system or shut off the air supply to a ventilated system. Note: The inside of the ports is sterile.
4. Hanging on the infusion stand
(see Fig. 12).
Hang the bag on the rack using the hole on the holder (Fig. 12).
Overdose of the drug Kabiven central, symptoms and treatment
An impaired ability to eliminate fat can lead to the development of fat overload syndrome. This may result from overdose, but may also occur at the recommended infusion rate if the patient's clinical condition changes dramatically and severe renal or hepatic impairment develops. Fat overload syndrome is characterized by hyperlipidemia, fever, hepatosplenomegaly, anemia, leukopenia, thrombocytopenia, coagulopathy and coma. If this occurs, the infusion must be stopped. Nausea, vomiting, and excessive sweating may occur if the recommended rate of amino acid infusion is exceeded. In addition, overdose leads to disturbances in water-electrolyte balance, hyperglycemia and hyperosmolality. If symptoms of overdose occur, the infusion rate should be reduced or the infusion should be stopped. In case of severe overdose, hemodialysis, hemofiltration or hemodiafiltration are prescribed.
Kabiven central
The drug should not be administered through a peripheral vein.
Correction of water and electrolyte imbalances, as well as metabolic disorders, must be carried out before the start of the infusion.
Since the drug does not contain vitamins and microelements, when adding them, the doses of these substances (depending on the need) should be determined before the infusion and the osmolarity of the resulting solution should be calculated.
The drug should be used immediately after opening the container and should not be stored for the next infusion.
During the entire course of treatment with Kabiven central, monitoring of water and electrolyte balance, plasma osmolarity, CBS, blood glucose and liver function tests is necessary.
Plasma TG concentrations and the ability to remove lipids from the bloodstream should be assessed regularly.
The serum TG concentration during infusion should not exceed 3 mmol/l. Their concentration should be measured no earlier than 3 hours after the start of the infusion. If a disorder of lipid metabolism is suspected, it is recommended to repeat the same tests 5-6 hours after stopping the administration of the emulsion. In adults, lipid elimination should occur less than 6 hours after stopping the lipid emulsion infusion. The next infusion should be carried out only after the plasma TG concentration has normalized.
Regular clinical examination should be carried out for liver failure (due to the risk of onset or worsening of neurological disorders associated with hyperammonemia), renal failure (especially with hyperkalemia - risk of onset or worsening metabolic acidosis, hyperazotemia in the absence of hemofiltration or dialysis), diabetes mellitus (control of glucose concentration, glucosuria, ketonuria and insulin dose correction), blood coagulation disorders, anemia, hyperlipidemia.
With long-term use of Kabiven central (several weeks), blood counts and coagulogram should be monitored.
When selecting a dose, you should focus on the child’s age, protein and energy needs, as well as the disease. If necessary, proteins and/or “energy” components (carbohydrates, lipids) should be added enterally. For parenteral nutrition in children over 2 years of age, it is advisable to select the container volume in accordance with the daily dose. The addition of vitamins and microelements must be carried out in doses used in pediatrics according to age needs.
The infusion emulsion should not be administered in parallel with blood products through the same catheter due to the possibility of pseudoagglutination. If blood was drawn before lipids were eliminated from the plasma (usually 5-6 hours after stopping the emulsion), then the lipids contained in the emulsion may affect the results of some laboratory tests (including bilirubin, LDH, oxygen saturation , Hb).
Currently, there is no reliable data on the use of Kabiven central in pregnant women and nursing mothers; in such cases, the balance between the benefit to the mother and the potential risk to the fetus should be assessed.
Additional nutrients (including vitamins) can be added to the finished mixture. Vitamins can also be added to the dextrose solution section before the contents of the sections are mixed. The following components can be added to the prepared drug solution: electrolytes (the stability of the emulsion was maintained when adding no more than 150 mmol Na+, 150 mmol K+, 5.6 mmol Mg2+ and 5 mmol Ca2+ per 1 liter of the finished mixture), organic phosphates (the stability of the emulsion was maintained when adding up to 15 mmol per 1 packet), microelements and vitamins (the stability of the emulsion was maintained when adding doses not exceeding daily doses).
If fat overload syndrome occurs, the infusion of lipid emulsion should be stopped (symptoms are reversible).
If symptoms of an allergic reaction appear (fever, chills, skin rash, breathing problems), the central infusion of Kabiven should be stopped immediately.
Storage conditions Kabiven central
At a temperature not higher than 25 °C. Do not freeze! After opening the clamps, the chemical and physical stability of the mixed contents of the 3 chambers is maintained for 24 hours at a temperature of 25 °C. To ensure microbiological safety, the mixture should be used immediately after the addition of additives. If the mixture is not used immediately, then provided that aseptic conditions are observed when introducing additives, the emulsion mixture can be stored for up to 6 days at a temperature of 2–8 ° C, after which the mixture should be used within 24 hours.
List of pharmacies where you can buy Kabiven central:
- Moscow
- Saint Petersburg
Kabiven peripheral, 4 pcs., 1920 ml, emulsion for infusion
IV,
drip.
Kabiven® central
Only in the central veins. The infusion can be continued for as long as the patient’s clinical condition requires, based on the daily need for glucose, lipids and amino acids.
The dosage and rate of infusion are determined by the patient's ability to eliminate lipids and metabolize glucose.
Kabiven® central is available in bags of 4 sizes (for patients with normal, moderately increased or decreased need for nutrients). Total parenteral nutrition may require supplementation with vitamins, electrolytes, and micronutrients.
The dose should be selected individually and when choosing the size of the bag, take into account the patient’s condition, body weight and nutritional needs.
In obese patients, the dose should be set based on ideal body weight.
In patients with moderate to severe catabolic stress with or without malnutrition, amino acid requirements are 1–2 g/kg/day, corresponding to a nitrogen requirement of 0.15–0.3 g/kg/day. This corresponds to 27–40 ml of Kabiven® central per 1 kg of body weight per day.
In patients without severe catabolic stress, the amino acid requirement is 0.7–1.3 g/kg/day, which corresponds to a nitrogen requirement of 0.1–0.2 g/kg/day. This corresponds to 19–38 ml of Kabiven® central per 1 kg of body weight per day.
The maximum daily dose for adults is 40 ml/kg/day. This is equivalent to one bag (largest size 2566 ml) for a 64 kg patient and provides 1.3 g amino acids/kg/day (0.21 g nitrogen/kg/day), 31 kcal/kg/day non-protein energy, 3 .9 g glucose/kg/day and 1.6 g lipids/kg/day. The maximum daily dose depends on the clinical condition of the patient and may vary.
For children, dosage is determined by the patient's ability to metabolize individual nutrients. Infusion for children (from 2 to 10 years) should begin with low doses (14–28 ml/kg/day), then the dose should be increased by 10–15 ml/kg/day, to a maximum of 40 ml/kg/day. In children over 10 years of age, the same doses are used as in adults.
Infusion rate.
The infusion rate of Kabiven® central should not exceed 2.6 ml/kg/h, which corresponds to an infusion rate of glucose 0.25 g/kg/h, amino acids 0.09 g/kg/h and lipids 0.13 g/kg/h . The recommended duration of infusion of Kabiven® central is 12–24 hours.
Kabiven® peripheral
In peripheral or central veins. The infusion can be continued for as long as the patient’s clinical condition requires, based on the daily need for glucose, lipids and amino acids.
The dosage and rate of infusion are determined by the patient's ability to eliminate lipids and metabolize glucose.
Kabiven® peripheral is available in bags of 3 sizes (for patients with normal, moderately increased or decreased need for nutrients). Total parenteral nutrition may require supplementation with vitamins, electrolytes, and micronutrients.
The dose should be selected individually and when choosing the size of the bag, take into account the patient’s condition, body weight and nutritional needs.
In obese patients, the dose should be set based on ideal body weight.
In patients with moderate to severe catabolic stress with or without malnutrition, the amino acid requirement is 1–2 g/kg/day, which is approximately equal to the nitrogen requirement of 0.15–0.3 g/kg/day. The energy requirement is 30–50 kcal/kg/day.
In patients without catabolic stress, the amino acid requirement is 0.7–1 g/kg/day, which is approximately equal to the nitrogen requirement of 0.1–0.15 g/kg/day. The energy requirement is 20–30 kcal/kg/day. This corresponds to 27–40 ml of Kabiven® peripheral per 1 kg of body weight per day.
The maximum daily dose for adults is 40 ml/kg/day. This is equivalent to one bag (largest size 2400 ml) for a 64 kg patient and provides 0.96 g amino acids/kg/day (0.16 g nitrogen/kg/day), 25 kcal/kg/day non-protein energy, 2 .7 g glucose/kg/day and 1.4 g lipids/kg/day.
For children, dosage is determined by the patient's ability to metabolize individual nutrients. Infusion for children (from 2 to 10 years) should begin with low doses - 14–28 ml/kg/day, which corresponds to the daily intake of lipids, amino acids and glucose (0.49–0.98 g/kg, 0.34–0 .67 g/kg and 0.95–1.9 g/kg, respectively), then the dose should be increased by 10–15 ml/kg/day, maximum up to 40 ml/kg/day. In children over 10 years of age, the same doses are used as in adults.
Infusion rate.
The maximum glucose infusion rate is 0.25 g/kg/h. The dose of amino acids should not exceed 0.1 g/kg/hour. Lipid intake should be no more than 0.15 g/kg/h.
The infusion rate of Kabiven® peripheral should not exceed 3.7 ml/kg/h, which corresponds to an infusion rate of glucose 0.25 g/kg/h, amino acids 0.09 g/kg/h and lipids 0.13 g/kg/h . The recommended duration of infusion of Kabiven® peripheral is 12–24 hours.
Shelf life after mixing with additives
Once the fixatives are opened and the three solutions are mixed, compatible additives can be added to the mixture through the additive injection port.
Once the fixatives are released, the chemical and physical stability of the mixed contents of the three chambers is maintained for 24 hours at 25°C.
To ensure microbiological safety, the mixture should be used immediately after the addition of additives. If the mixture is not used immediately, provided asepsis is observed when adding additives, the emulsion mixture can be stored for up to 6 days at 2–8 °C, after which the mixture should be used within 24 hours.
Recommendations for preparing the Biofin container for use
Diagram of the Biofin container
(see Fig. 1).
1 - cut on the outer package; 2 - holder; 3 — hole for hanging the package; 4 - dividing partition; 5 — blind port (not used); 6 - port for introducing additives; 7 — port for infusion system; 8 — oxygen absorber (in the outer package).
1. Removing an external package
(see Fig. 2, 3).
Place the container on a horizontal surface. Tear the outer bag at the cut site by pulling along the edge (Fig. 2).
Remove the outer bag and throw it away along with the oxygen absorber (Fig. 3).
2. Mixing
(See Fig. 4–7).
Place the three-chamber bag on a horizontal surface. Roll the bag from the corner on the holder side diagonally towards the blind port (Fig. 4).
Then, holding the folded part with one hand and maintaining constant pressure inside the bag, apply force (press) with the other hand on the bag until the vertical partitions open (Fig. 5).
Vertical partitions open due to the pressure created by the contents of the package! There is no need to open the horizontal partition - the contents of the chambers are easily mixed after opening only the vertical partitions (Fig. 6).
Mix the contents of the chambers by turning the bag 2-3 times (Fig. 7). Note: The dividers can be opened before being removed from the outer bag, at which point the outer bag can be removed.
3. Connecting the infusion system
(See Fig. 8–11).
If it is necessary to introduce additives (with confirmed compatibility, for example, special preparations of vitamins, microelements, Dipeptiven), remove (break off) the cap with the arrow from the white port immediately before introducing the additives (Fig. 8).
While holding the base of the additive injection port, insert the needle completely through the center of the membrane and inject the confirmed compatible additive (Figure 9). Before adding another additive, thoroughly mix the contents by turning the bag over several times.
Connecting the infusion system: immediately before inserting the needle, remove the cap from the blue port (Fig. 10).
Holding the bag with the port for the infusion system facing up, insert the needle through the membrane, turning and pushing it if necessary (Fig. 11). Use a non-vented infusion system or shut off the air supply to a ventilated system. Note: The inside of the ports is sterile.
4. Hanging on the infusion stand
(see Fig. 12).
Hang the bag on the rack using the hole on the holder (Fig. 12).
Kabiven central, emulsion for infusion 1540ml 4 pcs. to Klin
IV,
drip.
Only in the central veins. The infusion can be continued for as long as the patient’s clinical condition requires, based on the daily need for glucose, lipids and amino acids.
The dosage and rate of infusion are determined by the patient's ability to eliminate lipids and metabolize glucose.
Kabiven® central is available in bags of 4 sizes (for patients with normal, moderately increased or decreased need for nutrients). Total parenteral nutrition may require supplementation with vitamins, electrolytes, and micronutrients.
The dose should be selected individually and when choosing the size of the bag, take into account the patient’s condition, body weight and nutritional needs.
In obese patients, the dose should be set based on ideal body weight.
In patients with moderate to severe catabolic stress with or without malnutrition, amino acid requirements are 1–2 g/kg/day, corresponding to a nitrogen requirement of 0.15–0.3 g/kg/day. This corresponds to 27–40 ml/kg/day of the drug Kabiven® central.
In patients without severe catabolic stress, the amino acid requirement is 0.7–1.3 g/kg/day, which corresponds to a nitrogen requirement of 0.1–0.2 g/kg/day. This corresponds to 19–38 ml/kg/day of the drug Kabiven® central.
The maximum daily dose for adults is 40 ml/kg/day. This corresponds to one bag (largest size 2566 ml) for a 64 kg patient and provides 1.3 g amino acids/kg/day (0.21 g/kg/day nitrogen), 31 kcal/kg/day non-protein energy, 3 .9 g/kg/day glucose and 1.6 g/kg/day lipids. The maximum daily dose depends on the clinical condition of the patient and may vary.
For children, dosage is determined by the patient's body's ability to metabolize individual nutrients. Infusion for children (from 2 to 10 years) should begin with low doses (14–28 ml/kg/day), then the dose should be increased by 10–15 ml/kg/day, to a maximum of 40 ml/kg/day. In children over 10 years of age, the same doses are used as in adults.
Infusion rate.
The infusion rate of the drug Kabiven® central should not exceed 2.6 ml/kg/h, which corresponds to an infusion rate of glucose 0.25 g/kg/h, amino acids 0.09 g/kg/h and lipids 0.13 g/kg/ h. The recommended duration of infusion of Kabiven® central is 12–24 hours.
Shelf life after mixing with additives
Once the fixatives are opened and the three solutions are mixed, compatible additives can be added to the mixture through the additive injection port.
Once the fixatives are released, the chemical and physical stability of the mixed contents of the three chambers is maintained for 24 hours at 25°C.
To ensure microbiological safety, the mixture should be used immediately after the addition of additives. If the mixture is not used immediately, then, provided asepsis is observed when introducing additives, the finished mixture can be stored for up to 6 days at 2–8 °C, after which the mixture should be used within 24 hours.
Recommendations for preparing the Biofin container for use
Diagram of the Biofin container
(see Fig. 1).
1 - cut on the outer package; 2 - holder; 3 — hole for hanging the package; 4 - dividing partition; 5 — blind port (not used); 6 - port for introducing additives; 7 — port for infusion system; 8 — oxygen absorber (in the outer package).
1. Removing an external package
(see Fig. 2, 3).
Place the container on a horizontal surface. Tear the outer bag at the cut site by pulling along the edge (Fig. 2).
Remove the outer bag and throw it away along with the oxygen absorber (Fig. 3).
2. Mixing
(See Fig. 4–7).
Place the three-chamber bag on a horizontal surface. Roll the bag from the corner on the holder side diagonally towards the blind port (Fig. 4).
Then, holding the folded part with one hand and maintaining constant pressure inside the bag, apply force (press) with the other hand on the bag until the vertical partitions open (Fig. 5).
Vertical partitions open due to the pressure created by the contents of the package! There is no need to open the horizontal partition - the contents of the chambers are easily mixed after opening only the vertical partitions (Fig. 6).
Mix the contents of the chambers by turning the bag 2-3 times (Fig. 7). Note: The dividers can be opened before being removed from the outer bag, at which point the outer bag can be removed.
3. Connecting the infusion system
(See Fig. 8–11).
If it is necessary to introduce additives (with confirmed compatibility, for example, special preparations of vitamins, microelements, Dipeptiven), remove (break off) the cap with the arrow from the white port immediately before introducing the additives (Fig. 8).
While holding the base of the additive injection port, insert the needle completely through the center of the membrane and inject the confirmed compatible additive (Figure 9). Before adding another additive, thoroughly mix the contents by turning the bag over several times.
Connecting the infusion system: immediately before inserting the needle, remove the cap from the blue port (Fig. 10).
Holding the bag with the port for the infusion system facing up, insert the needle through the membrane, turning and pushing it if necessary (Fig. 11). Use a non-vented infusion system or shut off the air supply to a ventilated system. Note: The inside of the ports is sterile.
4. Hanging on the infusion stand
(see Fig. 12).
Hang the bag on the rack using the hole on the holder (Fig. 12).
