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Cyclosporine level: difference between blood samples collected through peripheral and central venous access

Authors

  • Livia M Garbin,

    1. Authors:Livia M Garbin, RN, Clinical Nurse, University of São Paulo at Ribeirão Preto College of Nursing – EERP-USP, WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto; Marcela Tonani, RN, MSc, Clinical Nurse, Bone Marrow Transplantation (BMT) Unit, Hospital das Clínicas of the University of São Paulo at Ribeirão Preto Medical School – HCFMRP-USP, Ribeirão Preto; Michelle Salvador, RN, Clinical Nurse, Chemotherapy Central, HCFMRP-USP, Ribeirão Preto; Renata C de Campos Pereira Silveira, RN, PhD, Professor, EERP-USP, WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto; Júlio C Voltarelli, MD, Full Professor, FMRP-USP, BMT Unit Coordinator, HCFMRP-USP, Ribeirão Preto; Claudia B dos Santos, PhD, Professor, EERP-USP, WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto; Emília C Carvalho, RN, Full Professor, EERP-USP, WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil
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  • Marcela Tonani,

    1. Authors:Livia M Garbin, RN, Clinical Nurse, University of São Paulo at Ribeirão Preto College of Nursing – EERP-USP, WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto; Marcela Tonani, RN, MSc, Clinical Nurse, Bone Marrow Transplantation (BMT) Unit, Hospital das Clínicas of the University of São Paulo at Ribeirão Preto Medical School – HCFMRP-USP, Ribeirão Preto; Michelle Salvador, RN, Clinical Nurse, Chemotherapy Central, HCFMRP-USP, Ribeirão Preto; Renata C de Campos Pereira Silveira, RN, PhD, Professor, EERP-USP, WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto; Júlio C Voltarelli, MD, Full Professor, FMRP-USP, BMT Unit Coordinator, HCFMRP-USP, Ribeirão Preto; Claudia B dos Santos, PhD, Professor, EERP-USP, WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto; Emília C Carvalho, RN, Full Professor, EERP-USP, WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil
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  • Michelle Salvador,

    1. Authors:Livia M Garbin, RN, Clinical Nurse, University of São Paulo at Ribeirão Preto College of Nursing – EERP-USP, WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto; Marcela Tonani, RN, MSc, Clinical Nurse, Bone Marrow Transplantation (BMT) Unit, Hospital das Clínicas of the University of São Paulo at Ribeirão Preto Medical School – HCFMRP-USP, Ribeirão Preto; Michelle Salvador, RN, Clinical Nurse, Chemotherapy Central, HCFMRP-USP, Ribeirão Preto; Renata C de Campos Pereira Silveira, RN, PhD, Professor, EERP-USP, WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto; Júlio C Voltarelli, MD, Full Professor, FMRP-USP, BMT Unit Coordinator, HCFMRP-USP, Ribeirão Preto; Claudia B dos Santos, PhD, Professor, EERP-USP, WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto; Emília C Carvalho, RN, Full Professor, EERP-USP, WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil
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  • Renata C de Campos Pereira Silveira,

    1. Authors:Livia M Garbin, RN, Clinical Nurse, University of São Paulo at Ribeirão Preto College of Nursing – EERP-USP, WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto; Marcela Tonani, RN, MSc, Clinical Nurse, Bone Marrow Transplantation (BMT) Unit, Hospital das Clínicas of the University of São Paulo at Ribeirão Preto Medical School – HCFMRP-USP, Ribeirão Preto; Michelle Salvador, RN, Clinical Nurse, Chemotherapy Central, HCFMRP-USP, Ribeirão Preto; Renata C de Campos Pereira Silveira, RN, PhD, Professor, EERP-USP, WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto; Júlio C Voltarelli, MD, Full Professor, FMRP-USP, BMT Unit Coordinator, HCFMRP-USP, Ribeirão Preto; Claudia B dos Santos, PhD, Professor, EERP-USP, WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto; Emília C Carvalho, RN, Full Professor, EERP-USP, WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil
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  • Júlio C Voltarelli,

    1. Authors:Livia M Garbin, RN, Clinical Nurse, University of São Paulo at Ribeirão Preto College of Nursing – EERP-USP, WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto; Marcela Tonani, RN, MSc, Clinical Nurse, Bone Marrow Transplantation (BMT) Unit, Hospital das Clínicas of the University of São Paulo at Ribeirão Preto Medical School – HCFMRP-USP, Ribeirão Preto; Michelle Salvador, RN, Clinical Nurse, Chemotherapy Central, HCFMRP-USP, Ribeirão Preto; Renata C de Campos Pereira Silveira, RN, PhD, Professor, EERP-USP, WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto; Júlio C Voltarelli, MD, Full Professor, FMRP-USP, BMT Unit Coordinator, HCFMRP-USP, Ribeirão Preto; Claudia B dos Santos, PhD, Professor, EERP-USP, WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto; Emília C Carvalho, RN, Full Professor, EERP-USP, WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil
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  • Claudia B dos Santos,

    1. Authors:Livia M Garbin, RN, Clinical Nurse, University of São Paulo at Ribeirão Preto College of Nursing – EERP-USP, WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto; Marcela Tonani, RN, MSc, Clinical Nurse, Bone Marrow Transplantation (BMT) Unit, Hospital das Clínicas of the University of São Paulo at Ribeirão Preto Medical School – HCFMRP-USP, Ribeirão Preto; Michelle Salvador, RN, Clinical Nurse, Chemotherapy Central, HCFMRP-USP, Ribeirão Preto; Renata C de Campos Pereira Silveira, RN, PhD, Professor, EERP-USP, WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto; Júlio C Voltarelli, MD, Full Professor, FMRP-USP, BMT Unit Coordinator, HCFMRP-USP, Ribeirão Preto; Claudia B dos Santos, PhD, Professor, EERP-USP, WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto; Emília C Carvalho, RN, Full Professor, EERP-USP, WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil
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  • Emília C Carvalho

    1. Authors:Livia M Garbin, RN, Clinical Nurse, University of São Paulo at Ribeirão Preto College of Nursing – EERP-USP, WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto; Marcela Tonani, RN, MSc, Clinical Nurse, Bone Marrow Transplantation (BMT) Unit, Hospital das Clínicas of the University of São Paulo at Ribeirão Preto Medical School – HCFMRP-USP, Ribeirão Preto; Michelle Salvador, RN, Clinical Nurse, Chemotherapy Central, HCFMRP-USP, Ribeirão Preto; Renata C de Campos Pereira Silveira, RN, PhD, Professor, EERP-USP, WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto; Júlio C Voltarelli, MD, Full Professor, FMRP-USP, BMT Unit Coordinator, HCFMRP-USP, Ribeirão Preto; Claudia B dos Santos, PhD, Professor, EERP-USP, WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto; Emília C Carvalho, RN, Full Professor, EERP-USP, WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil
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Renata Cristina de Campos Pereira Silveira, Professor, Universidade de São Paulo – Escola de Enfermagem de Ribeirão Preto, Avenida Bandeirantes 3900, Campus Universitário, Bairro Monte Alegre, Ribeirão Preto, SP CEP 14040-902, Brazil. Telephone: +55 16 3602 3434.
E-mail:recris@eerp.usp.br

Abstract

Aims and objectives.  To identify differences in cyclosporine levels between blood samples collected from a peripheral venous access, catheter line used for drug infusion and catheter line not used for drug infusion in adult patients receiving allogeneic haematopoietic stem cell transplantation.

Background.  Cyclosporine is an immunosuppressant that prevents graft-versus-host disease, has a narrow therapeutic window and causes nephrotoxicity. For cyclosporine infusion, a tunnelled central venous access device is used; however, because of the lipophilic properties of the drug, it can adsorb to the catheter surface and falsely raise cyclosporine concentrations in blood specimens.

Design.  Prospective observational study.

Methods.  The study collected 135 blood samples from 16 patients. In 13 subjects, samples were obtained from the three lines at three time points (1, 7 and 14 days after the start of cyclosporine infusion), and for three subjects, samples were only obtained at 1 and 7 days after the start of infusion. The 5-ml blood discard method was used for samples collected from the catheter. Using this procedure, the catheter line was washed with saline solution, 5 ml of blood and saline solution were aspirated from the catheter line and discarded, and then sample blood used for the test was collected. The paired t-test with the Bonferroni correction was used to analyse the differences in cyclosporine serum levels.

Results.  Significant differences were observed when the drug serum levels obtained in the line used for drug infusion were compared with the levels obtained in the line not used for infusion or the peripheral venous line. No differences in drug levels were identified in blood collected from the peripheral venous line and the line not used for drug infusion.

Conclusion.  Drug adsorption occurs in the line used for infusion. Therefore, the blood sample collected from the line not used for cyclosporine infusion can be considered reliable for drug concentration determination.

Relevance to clinical practice.  Nurses should standardise one line of the tunnelled central venous access device for cyclosporine infusion, which avoids the need for evasive procedures and provides patients with more comfort.

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