We are trying to implement the guidelines for ALT in pediatric patients on hemodialysis. But ran into an issue where stability of the final product lacks any supporting data.
Our list for ALT is:
1. Vancomycin 5mG/mL + heparin 1000 units/mL
2. Gentamicin 1 mG/mL + heparin 1000 units/mL
3. Cefazolin 5 mG/mL + heparin 1000 units/mL
Coming up with the guideline was easy, but operationalizing it a whole other issue. There is no stability data of these products at these concentrations published. So, the conversation is moving towards increasing the heparin concentration to 25,000 units/mL for each of the above listed ALTs. As, you may understand, there is a bit of reluctance with that for Pediatric population.
I was wondering how others are managing the issue. What does your process look like?