sodium-bicarbonate and Phlebitis

Prostaglandin E(1) (PGE(1); Alprostadil Alfadex) is a potent vasodilator and inhibitor of platelet aggregation used to treat patients with peripheral vascular disease. The main adverse effects of intravenous PGE(1) administration, phlebitis and venous pain, arise from the unphysiologically low pH of infusion solutions. When PGE(1) infusion solutions with a pH value greater then 6 are used, phlebitis and venous pain are considered to be avoidable. Beginning with a PGE(1) infusion solution with pH greater than 6, we add the amount of 7% sodium bicarbonate needed to bring the solution to pH 7.4 if phlebitis or venous pain develops. In the present study we established a convenient nomogram showing the relationship between the titratable acidity of various infusion solutions and the volume of 7% sodium bicarbonate required to attain pH 7.4 for preventing the phlebitis and venous pain associated with PGE(1) infusion.

Topics: Alprostadil; Humans; Hydrogen-Ion Concentration; Infusions, Intravenous; Pain; Phlebitis; Sodium Bicarbonate; Solutions

Previous studies have shown moderate or severe phlebitis at the site of venipuncture in some patients who receiving prostaglandin E1 (PGE1) infusion therapy. Such phlebitis is sometimes severe enough to necessitate the cessation of PGE1 therapy. This study investigated how to continue PGE1 infusion therapy for 3 weeks with tolerable phlebitis. Although a 60 microg dose of PGE1 is usually dissolved in 500 mL of fluid to avoid phlebitis, we used 200 mL to prevent volume overload. This PGE1 solution was neutralized to pH 7.4 with 4 mL of 7% sodium bicarbonate. We examined the frequency and severity of phlebitis among patients who received a 2-h PGE1 infusion twice daily. Eighteen patients who were hospitalized for peripheral vascular disease between June 1998 and May 1999 were studied. All of them were men and their mean age was 63.3 +/- 8.9 years (range: 47-78 years). Fourteen patients had arteriosclerosis obliterans and four had Buerger's disease. When the severity of phlebitis was determined according to Dinley's criteria, two patients (11%) had grade 0, four patients (22%) had grade 1, eleven patients (61%) had grade 2, and one patient (6%) had grade 3 phlebitis. Usually, PGE1 infusion therapy is stopped when phlebitis reaches grade 4 or more, but there were no such cases in this study. We also found that aging was significantly correlated with a decrease in the severity of phlebitis (Spearman's rank correlation test: r = -0.545, p = 0.0193).

Topics: Adult; Age Factors; Aged; Alprostadil; Arterial Occlusive Diseases; Humans; Hydrogen-Ion Concentration; Infusions, Intravenous; Long-Term Care; Male; Middle Aged; Pharmaceutical Vehicles; Phlebitis; Phlebotomy; Risk Factors; Sodium Bicarbonate; Vasodilator Agents

Human fibrinogen was labeled with 99m-Technetium. Tin(II)-chloride in citric acid served as reducing agent for the pertechnetate-ion, eluted from a Mo-Tc-generator. Before adding the fibrinogen, the citric acid was always neutralized with sodium hydrogen carbonate. The influences on the quantity of fibrinogen bound 99m-Tc of the relative concentrations of Sn(II), fibrinogen and sodium hydrogen carbonate, of the reaction time and temperature were tested by thin-layer chromatography. The reaction temperature of 28 degrees C showed an optimum of fibrinogen bound 99m-Tc for the reaction time from 1 and 2 hours. With a reaction time of 30 minutes not enough 99m-Tc was bound to fibrinogen, the doubling of the reaction time from 1 to 2 hours showed only an increase of binding of less than 4%. The concentration of Sn(II) with respect to the fibrinogen concentration showed no influence on the quantity of fibrinogen bound 99m-Tc at low Sn(II)-concentrations. At values higher than 34 times of the fibrinogen concentration a decrease of the quantity of bound 99m-Tc was observed. The concentrations of sodium hydrogen carbonate showed no influence on the quantity of fibrinogen bound 99m-Tc but on the clottability of fibrinogen, the pH of the solution must be approximately 7.5. In 3 parallel and independent experiments under optimized conditions (1 hour at 28 degrees C, molar ratio of Sn(II) : fibrinogen = 8.5, pH = 7.5) 89.97 +/- 0.92 % of 99 m-Tc were bound to fibrinogen. Controls of these results by column chromatography showed a binding of 81.08 +/- 1.47 % of 99m-Tc to fibrinogen. The clottability of fibrinogen tested by the method of Clauss (1) was entirely preserved.

Topics: Bicarbonates; Fibrinogen; Hydrogen-Ion Concentration; Isotope Labeling; Phlebitis; Radionuclide Imaging; Sodium Bicarbonate; Sodium Pertechnetate Tc 99m; Technetium; Temperature; Time Factors; Tin; Tin Compounds