Standard Operating Procedure for the preparation and intravenous infusion of glucose stable isotopes

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Elmer Holt
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Standard Operating Procedure for the preparation and intravenous infusion of glucose stable isotopes Effective date: 25.07.2017 Review due date: 28.11.

1 Standard Operating Procedure for the preparation and intravenous infusion of glucose stable isotopes Effective date: Review due date: Original Author Name: Javier Gonzalez Position: Lecturer Date: Reviewer Name: Pippa Heath Signature: Position: Physiology Lab Technician Date: Approved by Name: Dr Lisa Austin Position: DfH Research Manager Date: Signature: Amendment Chronology Version Effective Reason for amendment Reviewed/Amended by number date First issue Javier Gonzalez Reviewed, no amendments Pippa Heath

2 Safety Information: Ensure that you have had appropriate training and have read the relevant operator s manual/s and any specific documentation prior to using the equipment or undertaking the following task. Only individuals who have undergone the required training, and read and understood the risk assessment, may perform this procedure. Best practice must be adhered to at all times. Prior to performing this procedure please refer to the following risk assessments: o RA_cannulation o isotope_infusion Purpose: The purpose of a glucose stable isotope (tracer) infusion is to be able to determine the dynamics (rate of appearance and rate of clearance) of glucose for research purposes. Clean and disinfected preparation work surfaces and sterile procedures are required to prevent cross-contamination or infection of individuals. General Operation: Contents 1. Equipment Required 2. Preparation of Infusate 3. Infusate Draw 4. Starting an Infusion 5. Ordering Information 1. Equipment Required Preparation 70% Ethanol in a Squirt Bottle Alcohol Prep pads Enclosed working cabinet with laminar flow hood Analytical Balance in cabinet Sterile Drapes Sterile urine cups 60 ml luer tip Syringes 20 ml Syringe 3-way Stopcock 100 ml saline bottles 0.2 micron filters I.V. Extension Line 1.5 m

3 18 Gauge needles Latex free gloves Glucose tracer sterility and pyrogenicity certified Infusion Alaris PK Syringe infusion pump (RS232) Analytical Balance Latex free gloves 2. Preparation of Infusate 2.1 Prepare an excel worksheet (or use/adapt the Master Copy: xdrive/health/groups/sport & exercise science/staff_area/physiology/stable isotopes) to calculate and record, desired and actual, tracer weights and saline volumes. 2.2 Put on a pair of latex free gloves before gathering all the equipment required. 2.3 Rinse gloves with 70% ethanol. Wipe down enclosed working cabinet and analytical balance with 70% ethanol. Ensure that all surfaces of the cabinet and analytical scales (inside and out) are clean. 2.4 Rinse gloves with 70% ethanol and then open up the packet of the sterile drape. Drop the drape onto the sterile surface of the cabinet being careful not to touch the drape. 2.5 Drop all the pre-packaged (sterile) materials from their packets onto the drape in the cabinet, in much the same way as with the drape - being careful not to make contact with the sterile items. 2.6 Other materials required, including urine cups, saline bottles and tracer, should be wiped down with 70% ethanol before being placed in the cabinet on the drape. 2.7 Rinse gloves again with 70% ethanol before placing a sterile urine cup onto the balance with the lid off. 2.8 Place the urine cup lid on the sterile drape and then zero the analytical balance with the urine cup on it, being sure to close the scale doors (scale weight is heavier with doors closed). 2.9 Weigh out the desired amount of tracer required for infusate (taken from the spreadsheet) in to a sterile urine cup. Gently tap tracer out of the bottle to weigh the desired amount, and then record this amount with the scale doors closed, for a more accurate pump rate calculation Be sure to record the tracer lot #, and reseal around tracer cap with parafilm before storing securely in a locked cabinet. Ensure that gloves are rinsed with 70% ethanol between each tracer addition.

4 2.11 Carefully attach a sterile 18G needle to a sterile 60 ml luer tip syringe before unsheathing the needle to withdrawal saline from the bottle, then add the desired volume of saline in to the infusate containing-urine cup. Weigh and record the volume of saline added to the tracer Repeat steps 7-10 using a new urine cup to prepare the prime bolus dose Once both the infusate and prime are prepared, replace the caps and secure with parafilm. 3. Preparation of Infusate 3.1 Once the tracer has dissolved, attach a sterile 18-G needle to a labeled, sterile, 60mL luer tip syringe and aspirate the infusate into the appropriately labelled syringe (marker pen). Repeat using a 20 ml luer syringe for the prime. 3.2 Remove the needle from the infusate syringe, and attach the following in order, to the syringe: a 3-way stopcock, a 0.2 micron syringe filter and I.V. Extension Line (1.5 m). Depending on the volume of infusate you may need two syringes. 3.3 For the prime attach the 0.2 micron filter directly to the syringe and then place a sterile plastic cap on the exposed end of the filter. 3.4 Wrap the infusate and primer syringes in the sterile drape and securely store overnight at 4 0 C for use the following day. 4. Starting an infusion 4.1 Put on a pair of latex free gloves before gathering all equipment required. 4.2 Cannulate the participant in an antecubital vein in accordance with the following SOP: o Cannulation_SOP 4.3 Unwrap syringes from sterile packaging. 4.4 Mark on the syringes where the plunger is located. 4.5 Weight the syringes with connecting tube on analytical balance scales and record mass. 4.6 Attach the prime syringe onto the cannula and infuse the desired amount. 4.7 To begin the constant infusion, turn on infusion pump.

5 4.8 Confirm profile: press yes. 4.9 TCI mode: no Set at ml/h Secure syringe in infusion pump Press confirm Set pump rate to achieve desired infusion rate Press confirm Turn stopcock to open syringe and press green button At the end of the infusion period, stop the infusion by pressing the red button ion the infusion pump Record the total volume infused to calculate accurate infusion rates Close stopcock on the cannula and remove the infusion line Remove the cannula according in accordance with the SOP: o Cannulation_SOP End of Document

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