A glutamine containing dipeptide in high concentration may be given safely via the peripheral route in ICU-patients

The need for glutamine supplementation in catabolic states is well established. In ICU-patients the majority is fed by the enteral route. However, the documentation and control of glutamine administration enterally is still insufficient, while parenterally provided glutamine is well documented. Concentrated dipeptide solution may be given in a central venous line as a nutritional adjunct, but as central venous lines are associated with complications and risks, administration via a peripheral vein would be preferable. The osmolarity of a 20% glutamine dipeptide solution is 920 mosmol/l, which exceeds the recommended limit of 800 mosmol/l. Therefore we systematically evaluated local tolerance in a group of ICU-patients.

Patients and methods

ICU-patients (n = 20) on ventilator, but with limited liver and kidney insufficiency and with available peripheral vein were randomised to receive a 20% alanyl-glutamine (Dipeptiven, Fresenius-Kabi) infusion of 0.5 g/kg or the same volume of saline during 4 h in a peripheral vein on 3 consecutive days. The venous lines (BD Venflon^® i.v.; 1.0 mm diameter) were inserted especially for this purpose, and removed after each infusion. Different veins in the same arm were used. Local tolerance was evaluated clinically by Maddox score, and ultrasonically (Aspen^™ Ultrasound System equipped with L10 transducer with frequency 11–6 MHz) before the infusion and on days 1, 4 and 8 after the infusion.

Results

In the study 56 out of 60 (93%) planned infusions were administered and 157 out of 168 (93%) clinical evaluations were successfully performed. The ultrasonic evaluation revealed that the utilized veins had a diameter of 2.15 ± 0.8 mm (mean ± SD; range 1.0–4.4 mm; n = 56) 3 cm proximal of the insertion site. Using the protocol described above, there were no signs of thrombophlebitis in any single patients by either Maddox score or ultrasound.

Conclusion

Administration of glutamine-containing dipeptide concentrate (20%) by peripheral veins is safe in terms of local tolerance, if a strict protocol is adapted for this purpose involving a separate line for the infusion removed immediately afterwards.