Establishing a protocol for the compatibilities of closed-system transfer devices with multiple chemotherapy drugs under simulated clinical conditions

Closed-system drug transfer devices (CSTDs) are used to prevent occupational exposure to hazardous drugs in health care providers. They are considered Class II medical devices by the US FDA and are cleared but not approved before marketing. While compatibility tests are conducted by CSTD manufacturers, the procuring institution needs to consider performing its own studies before buying these devices. Herein we tested the compatibility of the components of the Needleless® DualGuard CSTD system (vial access clips, vial access spikes, and administration adaptors) with 10 antineoplastic drugs, under simulated clinical conditions, including compounding and administration, and examined drug potency maintenance, plasticizer migration, and device functionality. All drugs maintained potency within 5%. Diisononyl phthalate leakage was observed from the administration adaptors for paclitaxel and concentrated etoposide solution. In addition, white particles were discovered in CSTDs storing busulfan solution and small cracks were observed on devices which stored melphalan. Thus, it was concluded that even in simulated clinical conditions, instead of extreme conditions, there are still concerns regarding the efficacy and safety of CSTD components. The methodology may be used to implement and detect possible interactions between antineoplastic agents and CSTD components before procurement.

Specification and Evaluation of Plasticizer Migration Simulants for Human Blood Products: A Delphi Study

Potentially toxic plasticizers are commonly added to polyvinyl chloride medical devices for transfusion in order to improve their flexibility and workability. As the plasticizers are not chemically bonded to the PVC, they can be released into labile blood products (LBPs) during storage. Ideally, LBPs would be used in laboratory studies of plasticizer migration from the medical device. However, short supply (i.e., limited stocks of human blood in collection centres) has prompted the development of specific simulants for each type of LBP in the evaluation of new transfusion devices. We performed a Delphi study with a multidisciplinary panel of 24 experts. In the first (qualitative) phase, the panel developed consensus definitions of the specification criteria to be met by each migration simulant. Next, we reviewed the literature on techniques for simulating the migration of plasticizers into LBPs. A questionnaire was elaborated and sent out to the experts, and the replies were synthesized in order to obtain a consensus. The qualitative study established specifications for each biological matrix (whole blood, red blood cell concentrate, plasma, and platelet concentrate) and defined the criteria required for a suitable LBP simulant. Ten criteria were suggested: physical and chemical characteristics, opacity, form, stability, composition, ability to mimic a particular clinical situation, ease and safety of use, a simulant–plastic interaction correlated with blood, and compatibility with analytical methods. The questionnaire data revealed a consensus on the use of natural products (such as pig’s blood) to mimic the four LBPs. Opinions diverged with regard to synthetic products. However, an isotonic solution and a rheological property modifier were considered to be of value in the design of synthetic simulants. Consensus reached by the Delphi group could be used as a database for the development of simulants used to assess the migration of plasticizers from PVC bags into LBPs.

Sustainable Micro and Nano Additives for Controlling the Migration of a Biobased Plasticizer from PLA-Based Flexible Films

Plasticized poly(lactic acid) (PLA)/poly(butylene succinate) (PBS) blend-based films containing chitin nanofibrils (CN) and calcium carbonate were prepared by extrusion and compression molding. On the basis of previous studies, processability was controlled by the use of a few percent of a commercial acrylic copolymer acting as melt strength enhancer and calcium carbonate. Furthermore, acetyl n-tributyl citrate (ATBC), a renewable and biodegradable plasticizer (notoriously adopted in PLA based products) was added to facilitate not only the processability but also to increase the mechanical flexibility and toughness. However, during the storage of these films, a partial loss of plasticizer was observed. The consequence of this is not only correlated to the change of the mechanical properties making the films more rigid but also to the crystallization and development of surficial oiliness. The effect of the addition of calcium carbonate (nanometric and micrometric) and natural nanofibers (chitin nanofibrils) to reduce/control the plasticizer migration was investigated. The prediction of plasticizer migration from the films’ core to the external surface was carried out and the diffusion coefficients, obtained by regression of the experimental migration data plotted as the square root of time, were evaluated for different blends compositions. The results of the diffusion coefficients, obtained thanks to migration tests, showed that the CN can slow the plasticizer migration. However, the best result was achieved with micrometric calcium carbonate while nanometric calcium carbonate results were less effective due to favoring of some bio polyesters’ chain scission. The use of both micrometric calcium carbonate and CN was counterproductive due to the agglomeration phenomena that were observed.