from B. Braun Medical Inc.

CHOOSING THE APPROPRIATE PRODUCTS FOR YOUR PHARMACY IS OFTEN A multi-step decision-making process. Among other concerns, consideration must be given to efficacy and utility, safety for both the patient and staff, environmental impact, and of course, cost.

The evaluation of DEHP-free products in a health system is often based on the desire to reduce patients’ cumulative exposure to DEHP. While individual products may be considered safe, safety cannot be an isolated measurement. Hence, the cumulative load or exposure to DEHP must be analyzed. Following an analysis of all sources of DEHP within an institution, the choice to move to DEHP-free products in situations where there are clear alternatives, particularly in products where there is a leaching risk, is often the first step.

The University of Southern California’s Norris Cancer Hospital, an oncology-research center for adult patients, moved to DEHP-free purchasing more than 20 years ago. Evelyn Wing, the hospital’s pharmacy purchasing coordinator, noted that her institution uses B. Braun’s DEHP-free, PVC-free partial-additive bag (PAB), and the DEHP-free, PVC-free largevolume container, EXCEL, as part of their DEHP-free initiative.

Because Norris Cancer Hospital runs many National Institutes of Health (NIH) and National Cancer Institute (NCI) trials, they have very strict protocols, including a stringent evaluation policy for all of their purchases. “It is very important for us in every trial to start with products that would have minimal or no potential to add any risk or introduce any other factors to the drug we are studying, which is why we chose to use DEHP-free products,” notes Wing.

With the goal of finding a material that was inert and as good as, or better, than the glass evacuated containers they had been using, Norris chose B. Braun’s PAB and EXCEL IV containers. “In terms of cumulative exposure, our patients come back for their therapy in cycles from every two to four weeks. Therefore, if there is a cumulative effect, our patients would be at higher risk for DEHP exposure. Our answer to this concern is: If you know there is a potential risk, it is better to eliminate it. A little over 20 years ago, when we started purchasing DEHP-free products, we took a very scientific approach. Then and now, we are looking at the drug and its effect on the patient; any outside factors are just going to complicate things. Because these products are as good as inert, we continue to purchase the PAB and EXCEL IV containers.”

Pharmacy is an obvious choice to take a leadership role in moving the health system toward purchasing DEHP-free products. At the Norris Cancer Center, Wing points out, “because we purchase a lot of IV solutions, our pharmacy takes control and ownership of this process.”

To meet these purchasing requirements, B. Braun offers a complete line of large-volume parenteral solutions in EXCEL and PAB PVC-free and DEHP-free plastic containers. These containers feature a biologically inert, non-toxic plastic construction. EXCEL and PAB containers are easy to handle, and have rigid ports for easier set-port and med-port manipulations. These unique PVC-free and DEHP-free designs provide for a safe, accurate means of administering IV medication.

The environmental impact of IV-bag disposal is also minimized by opting for products that are PVC-free. The disposal of PVC-free bags in landfills—where they require less space and will not leach harmful chemicals into the soil or ground water—costs up to 30% less annually than the disposal of PVC containers.

Wing concludes, “We are quite happy with our choice of the EXCEL and the PAB containers. To me it was a no-brainer; basically, we needed something inert, the price was competitive, and there were no disadvantages to this choice.”