Aktuelle Ernährungsmedizin 2004; 29 - 8
DOI: 10.1055/s-2004-824916

Vitamin C Stability in Total Parenteral Nutrition: Critical Influence of „All-In-One“ Bag Properties

YM Dupertuis 1, S Ramseyer 2, M Fathi 2, C Pichard 1
  • 1Clinical Nutrition, University Hospitals of Geneva, Switzerland
  • 2Central Laboratory, University Hospitals of Geneva, Switzerland

Aims: Recent development of multilayered (ML) bags has enabled to greatly diminish the vitamin C oxidation that occurs between total parenteral nutrition (TPN) admixture compounding and patient's infusion. However, the extent of the gas-barrier property of ML bags depends on the combination of plastic films used. This study aimed to assess vitamin C stability in three different ML bags following variations in temperature and storage time.

Methods: Oxygen infiltration and vitamin C stability were assessed in three different ML bags of identical wall thickness, using gas chromatography and iodometric assay or high-pressure liquid chromatography (HPLC), respectively. Before vitamin injection, the ML bags were filled with 2500 mL of either a mixture of distilled water and 40g carbohydrates, for iodometric assay, or a complete TPN mixture including carbohydrates (330g), lipids (100g), amino acids (96g) and trace elements, for HPLC analysis. The ML bags were then stored at 4, 21 or 40°C. Vitamin C concentration in ML bags was measured over 48h.

Results: Oxygen infiltration was markedly reduced in the six-layered bag (6L: 0.5 mL O2/m2/day) containing a gas-impermeable plastic layer, compared to the two three-layered bags, one more rigid (3L: 150 mL O2/m2/day), another more flexible (3Lf: 1500 mL O2/m2/day). According to these gas-chromatography results, vitamin C in complete TPN mixture was more stable in the 6L bag (half-life: ≥ 16 days up to 40°C) than in the 3L bag (half-life: 9 days at 4°C, 47h at 21°C and 29h at 40°C) and the 3Lf bag (half-life: 15h at 4°C, 10h at 21°C and 6h at 40°C).

Conclusions: Near complete prevention of vitamin C degradation in „all-in-one“ TPN bags should be possible, regardless of the room temperature, by combining plastic films with different properties. However, the best compromise between impermeability and flexibility remains to be found in order to avoid cracks in the bag wall.

Contact: Yves M. Dupertuis; Clinical Nutrition, University Hospital of Geneva; 24 rue Micheli-du-Crest, 1211 Genève 14; Switzerland; Telephone number (0041-22-372-33-89); Fax number (0041-22-372-93-63); e-mail (Yves.M.Dupertuis@hcuge.ch)