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Cyclosporine level: difference between blood samples collected through peripheral and central venous access

Livia M Garbin1, Marcela Tonani, Michelle Salvador

  • 1University of São Paulo at Ribeirão Preto College of Nursing - EERP-USP, WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil.

Journal of Clinical Nursing
|July 19, 2012
PubMed

Insights

Cyclosporine levels are falsely elevated when drawn from infusion lines due to drug adsorption. Blood samples from non-infusion lines provide reliable cyclosporine concentration measurements in transplant patients.

Area of Science:

  • Pharmacology and Therapeutics
  • Clinical Chemistry
  • Transplantation Medicine

Background:

  • Cyclosporine is a critical immunosuppressant for preventing graft-versus-host disease after allogeneic haematopoietic stem cell transplantation.
  • This drug has a narrow therapeutic window and potential for nephrotoxicity, necessitating accurate therapeutic drug monitoring.
  • Lipophilic drugs like cyclosporine can adsorb to central venous catheters, potentially leading to inaccurate blood concentration readings.

Purpose of the Study:

  • To compare cyclosporine levels in blood samples drawn from different central venous access device (CVAD) lines.
  • To determine if blood drawn from a CVAD line used for cyclosporine infusion differs from samples drawn from a non-infusion line or peripheral venous access.
  • To establish reliable methods for cyclosporine level monitoring in patients undergoing allogeneic haematopoietic stem cell transplantation.

Main Methods:

  • A prospective observational study involving 16 adult patients receiving allogeneic haematopoietic stem cell transplantation.
  • Blood samples were collected from peripheral venous access, a CVAD line used for drug infusion, and a CVAD line not used for infusion at multiple time points.
  • A 5-ml blood discard method was employed for samples drawn from catheter lines to minimize dilution and adsorption effects.

Main Results:

  • Significantly higher cyclosporine levels were observed in samples drawn from the CVAD line used for drug infusion compared to non-infusion lines and peripheral venous samples.
  • No significant differences in cyclosporine levels were detected between peripheral venous samples and samples from the non-infusion CVAD line.
  • These findings indicate drug adsorption to the catheter material during infusion.

Conclusions:

  • Drug adsorption to the catheter lumen occurs when cyclosporine is infused via a CVAD.
  • Blood samples collected from a CVAD line not used for cyclosporine infusion are reliable for accurate drug concentration determination.
  • Standardizing a dedicated CVAD line for cyclosporine infusion can improve patient comfort and avoid invasive procedures for sample collection.
Abstract

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