Travasol

TRAVASOL- leucine, phenylalanine, lysine hydrochloride, methionine, isoleucine, valine, histidine, threonine, tryptophan, alanine, glycine, arginine, proline, tyrosine and serine injection
Baxter Healthcare Corporation

1 INDICATIONS AND USAGE

TRAVASOL is indicated as a source of amino acids for patients requiring parenteral nutrition when oral or enteral nutrition is not possible, insufficient, or contraindicated. TRAVASOL may be used to treat negative nitrogen balance in patients.

2 DOSAGE AND ADMINISTRATION

2.1 Important Preparation Information

TRAVASOL is supplied as a pharmacy bulk package for admixing only and is not for direct intravenous infusion. Prior to administration, TRAVASOL must be transferred to a separate parenteral nutrition container, diluted and used as an admixture with or without dextrose, electrolytes and/or lipid emulsion.

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The key factor in preparation is careful aseptic technique to avoid inadvertent touch contamination during mixing of solutions and addition of other nutrients.

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Do not remove container from overpouch until ready to use.

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Tear protective overpouch across top at slit and remove solution container. Small amounts of moisture may be found on the solution container from water permeating from inside the container. The amount of permeated water is insufficient to affect the solution significantly. If larger amounts of water are found, the container should be checked for tears or leaks.

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Inspect TRAVASOL prior to use. Some opacity of the plastic due to moisture absorption during the sterilization process may be observed. This is normal and does not affect the solution quality or safety. The opacity will diminish gradually.

Evaluate the following:

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If the outlet port protector is damaged, detached, or not present, discard container as solution path sterility may be impaired.

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Check to ensure the solution is clear, colorless or slightly yellow. Discard if the solution is bright yellow or yellowish brown.

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Check for minute leaks by squeezing inner container. If leaks are found, discard container.

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TRAVASOL is intended for use in the preparation of sterile, intravenous admixtures. Because additives may be incompatible with TRAVASOL, evaluate all additions for compatibility.

2.2 Administration Instructions

TRAVASOL is for admixing use only. It is not for direct intravenous infusion. Prior to administration, TRAVASOL must be diluted with other compatible intravenous fluids or used as an admixture with or without dextrose, electrolytes and/or lipid emulsion.

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TRAVASOL is to be used only in a suitable work area such as a laminar flow hood (or an equivalent clean air compounding area). The key factor in the preparation is careful aseptic technique to avoid inadvertent touch contamination during mixing of solutions and addition of other nutrients.

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TRAVASOL is for admixing with dextrose injection and/or lipid emulsions using a parenteral nutrition container.

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When TRAVASOL is admixed with dextrose injection and/or lipid emulsion, the choice of a central or peripheral venous route should depend on the osmolarity of the final infusate. Solutions with greater than 5% dextrose or with osmolarity of 900 mOsm/L or greater must be infused through a central venous catheter [see Warnings and Precautions (5.6)].

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Use a dedicated line for parenteral nutrition solutions.

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Intravenous lipid emulsions can be infused concurrently into the same vein as TRAVASOL-dextrose solutions by a Y-connector located near the infusion site; flow rates of each solution should be controlled separately by infusion pumps.

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For administration without lipid emulsion, use a 0.22 micron in-line filter. If lipid emulsion is also administered, use a 1.2 micron in-line filter

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To prevent air embolism, use a non-vented infusion set or close the vent on a vented set, avoid multiple connections, do not connect flexible containers in series, fully evacuate residual gas in the container prior to administration, do not pressurize the flexible container to increase flow rates, and if administration is controlled by a pumping device, turn off pump before the container runs dry.

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If admixed or infused with lipid emulsion, do not use administration sets and lines that contain di-2-ethylhexyl phthalate (DEHP). Administration sets that contain polyvinyl chloride (PVC) components have DEHP as a plasticizer.

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Calcium and phosphate ratios must be considered. Excess addition of calcium and phosphate, especially in the form of mineral salts, may result in the formation of calcium phosphate precipitates [see Warnings and Precautions (5.1)].

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Prior to infusion, visually inspect the diluted parenteral nutrition solution containing TRAVASOL for particulate matter. The solution should be clear and there should be no precipitates. A slight yellow color does not alter the quality and efficacy of this product. If lipid has been added, ensure the emulsion has not separated. Separation of the emulsion can be visibly identified by a yellowish streaking or the accumulation of yellowish droplets in the mixed emulsion. Discard the admixture if any of the above are observed.

​ 2.3 Preparation Instructions for Admixing Using a Parenteral Nutrition Container

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Open by tearing protective overwrap across top at slit and remove solution container. If overpouch has been previously opened or is damaged, discard solution.

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If the outlet port protector is damaged, detached, or not present, discard the container.

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Some opacity of the plastic due to moisture absorption during the sterilization process may be observed.

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Check for minute leaks by squeezing the inner container firmly. If leaks are found, discard solution.

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Once the protective foil overwrap has been removed, suspend container from eyelet support.

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Remove plastic protector from outlet port at bottom of container.

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Attach solution transfer set. Refer to complete directions accompanying set. Note: The closure shall be penetrated only one time with a suitable sterile transfer device or dispensing set which allows measured dispensing of the contents.

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Prepare the admixture into the parenteral nutrition container using strict aseptic techniques to avoid microbial contamination.

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Do not add the lipid emulsion to the parenteral nutrition container first; destabilization of the lipid emulsion may occur from such an admixture.

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TRAVASOL may be mixed with dextrose injection and/or lipid emulsion. The following proper mixing sequence must be followed to minimize pH related problems by ensuring that typically acidic dextrose injections are not mixed with lipid emulsions alone:

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Transfer dextrose injection to the parental nutrition pooling container.

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Transfer amino acid injection.

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Transfer lipid emulsion.

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Because additives may be incompatible, evaluate all additions to the parenteral nutrition container for compatibility and stability of the resulting preparation. Consult with pharmacist, if available. Questions about compatibility may be directed to Baxter. If it is deemed advisable to introduce additives to the parenteral nutrition container, use aseptic technique.

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Use gentle agitation during admixing to minimize localized concentration effects; shake containers gently after each addition.

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Alternatively, simultaneous transfer to the parenteral nutrition container of TRAVASOL, dextrose injection and lipid emulsion is also permitted.

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For admixing using an automated device, refer to Instructions for Use of the applicable device.

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The prime destabilizers of emulsions are excessive acidity (such as pH below 5) and inappropriate electrolyte content. Give careful consideration to additions of divalent cations (Ca++ and Mg++), which have been shown to cause emulsion instability. Amino acid solutions exert buffering effects that protect the emulsion.

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Inspect the final parenteral nutrition solution containing TRAVASOL to ensure that:

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Precipitates have not formed during the mixing or addition of additives.

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The emulsion has not separated. Separation of the emulsion can be visibly identified by a yellowish streaking or the accumulation of yellowish droplets in the admixed emulsion.

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Discard the admixture if any of the above are observed.

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Containers should not be written on directly since ink migration has not been investigated. Affix accompanying label for date and time of entry.

Stability and Storage

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Use for admixing should be limited to up to 4 hours at room temperature (25ºC/77ºF) after the container closure has been penetrated.

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Admixtures should be used promptly with storage under refrigeration 2° to 8°C (36° to 46°F) not to exceed 24 hours and must be completely used within 24 hours after removal from refrigeration. Any mixture remaining must be discarded.

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Protect the admixed parenteral nutrition solution from light.

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For single use only. Discard used container of TRAVASOL.