Olimel n9e

OLIMEL N9E, infusion emulsion
Please read the following information carefully before administration, as it contains
important information for the patient.

• Keep this leaflet for future reference.
• If you have any questions, consult your doctor or nurse.
• If the patient experiences any adverse reactions, including any not listed in this leaflet, inform your doctor or nurse immediately. See section 4.

Table of contents

1. What OLIMEL N9E, infusion emulsion is and what it is used for
2. Important information before administration of OLIMEL N9E, infusion emulsion
3. How to use OLIMEL N9E, infusion emulsion
4. Possible side effects
5. How to store OLIMEL N9E, infusion emulsion
6. Contents of the pack and other information

1. What OLIMEL N9E, infusion emulsion is and what it is used for

OLIMEL is an infusion emulsion. The preparation is supplied in a three-compartment bag.
The first compartment contains a glucose solution with calcium, the second — a fat emulsion, and the third — an amino acid solution with other electrolytes.
OLIMEL is used for intravenous nutrition administered via a tube in adults and children over 2 years of age when oral nutrition is not appropriate.
OLIMEL may only be used under medical supervision.

2. Important information before administering OLIMEL N9E, infusion emulsion

When not to use OLIMEL N9E, infusion emulsion:

• in premature infants, newborns and children under 2 years of age;
• if the patient is allergic to eggs, soy, peanut proteins, corn/products containing corn (see also section "Warnings and precautions" below), or to any of the other components of this medicine (listed in section 6);
• if administration of certain amino acids causes an abnormal reaction in the patient;
• if the patient has markedly elevated blood lipid levels;
• if the patient has hyperglycemia (excessively high blood sugar levels);
• if the patient's blood contains abnormally high levels of any electrolyte (sodium, potassium, magnesium, calcium and/or phosphorus).

In each case, the physician will decide whether to administer the medicine based on factors such as the patient's age, body weight and overall health condition, including results of performed tests.

Warnings and precautions

Before starting administration of OLIMEL N9E, discuss this with the physician or nurse.
Too rapid infusion of parenteral nutrition solutions may result in patient injury or death.
If unusual signs or symptoms of an allergic reaction occur (such as sweating, fever, chills, headache, skin rash or breathing difficulties), the infusion must be stopped immediately.
The medicine contains soybean oil and egg phospholipids. Soy and egg proteins may cause hypersensitivity reactions. Cross-allergic reactions between soy proteins and peanuts have been observed.
OLIMEL contains glucose derived from corn, which may cause hypersensitivity reactions if the patient is allergic to corn or corn-containing products (see section "When not to use OLIMEL N9E, infusion emulsion:" above).

Breathing difficulties may also indicate formation of small particles blocking blood vessels in the lungs (pulmonary vessel deposits). If any breathing difficulties occur, inform the physician or nurse immediately. They will decide on appropriate actions.

The antibiotic ceftriaxone must not be mixed or administered simultaneously with any calcium-containing solutions (including OLIMEL) given by intravenous infusion. These medicines must not be administered simultaneously even through separate infusion lines or different infusion sites. However, OLIMEL and ceftriaxone may be administered sequentially if infusion lines are placed in different sites, or are replaced or thoroughly flushed with physiological saline solution between infusions to prevent precipitation (formation of calcium ceftriaxone particles).

Certain medicines and diseases may increase the risk of infection or sepsis (presence of bacteria in the blood). The risk of infection or sepsis is particularly high after insertion of a catheter (intravenous line) into the patient's vein. The physician will closely monitor the patient for any signs of infection. Patients requiring parenteral nutrition (administration of nutrients via a catheter placed in a vein) are at increased risk of infection due to their clinical condition. Strict aseptic procedures (ensuring absence of microorganisms) during catheter insertion, handling and preparation of the nutritional formulation (total parenteral nutrition) may reduce the risk of infection.

If the patient is severely malnourished and requires intravenous feeding, the physician should initiate treatment slowly. Concurrently, the patient should be closely monitored to prevent sudden changes in fluid volume, vitamin, electrolyte and mineral concentrations.
Before starting the infusion, any fluid and electrolyte imbalances and metabolic disturbances in the patient should be corrected. The physician will monitor the patient during therapy and may adjust the dosage or, if deemed appropriate, prescribe additional nutritional supplements such as vitamins, electrolytes and trace elements.

Liver function disorders, including impaired bile excretion (cholestasis), fat accumulation (hepatic steatosis), fibrosis potentially leading to liver failure, as well as cholecystitis and gallstones, have been reported in patients receiving intravenous nutritional therapy. The causes of these disorders are believed to vary among different patients. If the patient develops symptoms such as nausea, vomiting, abdominal pain, or yellowing of the skin or eyes, contact the physician to identify possible causes, contributing factors, and potential therapeutic or preventive measures.

Inform the physician:

• about severe kidney diseases. Also inform the physician if the patient is undergoing dialysis (artificial kidney) or other blood purification methods;
• about severe liver diseases;
• about blood coagulation disorders;
• about adrenal gland dysfunction (adrenal insufficiency). Adrenal glands are triangular-shaped glands located on top of the kidneys;
• about heart failure;
• about lung disease;
• about fluid accumulation in the body (overhydration);
• about insufficient body water (dehydration);
• about untreated high blood glucose levels (diabetes);
• about myocardial infarction or shock caused by sudden heart failure;
• about severe metabolic acidosis (excessively acidic blood);
• about systemic infection (sepsis);
• about coma.

To assess the effectiveness and safety of the medicine, the patient will undergo clinical and laboratory tests ordered by the physician during administration. If the medicine is administered for several weeks, the patient's blood will be tested regularly.

Reduced ability of the body to clear lipids contained in the administered preparation may lead to the so-called fat overload syndrome (see section 4 - "Possible side effects").
If pain, burning sensation, swelling at the infusion site or leakage of infused fluid occurs during infusion, inform the physician or nurse immediately. The infusion must be stopped immediately and may be restarted in another vein.

If blood glucose levels increase excessively, the physician should adjust the infusion rate of OLIMEL or administer insulin to normalize blood sugar levels.

OLIMEL may be administered through a catheter inserted into a large vein in the patient's chest (central vein).

Children and adolescents
When used in children under 18 years of age, particular caution is required to ensure correct dosing. Due to children's increased susceptibility to infection, enhanced precautions must be taken. Vitamin and trace element supplementation is always required. Pediatric formulations and dosages must be used for children.

OLIMEL and other medicines
Inform the physician about all medicines currently or recently taken or used by the patient, as well as any medicines the patient plans to take or use.

Concomitant use of other medicines is generally not contraindicated. However, inform the physician about all recently taken medicines, including those available without prescription, to check for compatibility.

Inform the physician about use or administration of:

• insulin,
• heparin.

OLIMEL must not be administered simultaneously with blood through the same infusion set.
OLIMEL contains calcium. It must not be administered together with the antibiotic ceftriaxone or through the same catheter, as particles may form. If these medicines are administered sequentially using the same device, it must be thoroughly flushed.

Due to the risk of precipitation, OLIMEL must not be administered through the same infusion line or mixed with ampicillin (an antibiotic) or fosphenytoin (an anticonvulsant).

The olive oil and soybean oil present in OLIMEL contain vitamin K. This usually does not affect the action of anticoagulant medicines (blood thinners) such as coumarin. However, if the patient is taking anticoagulant medicines, they should inform the physician.

Lipids contained in the emulsion may interfere with results of certain laboratory tests if blood samples are taken before lipids have been cleared from the patient's circulation (lipids are cleared from blood within 5 to 6 hours after lipid administration).

OLIMEL contains potassium. Exercise particular caution in patients taking diuretics, angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor antagonists (medicines used for hypertension) or immunosuppressive medicines. These medicines may cause increased blood potassium levels.

Pregnancy and breastfeeding
If the patient is pregnant or breastfeeding, suspects she may be pregnant, or plans to become pregnant, she should consult the physician before receiving this medicine.
There is insufficient experience regarding the use of OLIMEL N9E in pregnant or breastfeeding women. If necessary, administration of OLIMEL N9E may be considered during pregnancy and breastfeeding. OLIMEL N9E should be administered to pregnant or breastfeeding women only after careful consideration.

Driving and operating machinery
Not applicable.

3. How to use OLIMEL N9E, infusion emulsion

Dosage
OLIMEL must be used only in adults and in children above 2 years of age.
The medicine is an infusion emulsion administered via a catheter into a large vein in the patient's chest.
Before administration, OLIMEL should be at room temperature.
OLIMEL is intended for single use only.
Infusion of one bag usually lasts from 12 to 24 hours.

Dosage – Adults
The infusion rate will be determined by the physician according to the patient's needs and clinical condition.
The medicine may be administered as long as necessary, depending on the patient's clinical status.

Dosage – Children above two years of age and adolescents
The dose and duration of administration will be determined by the physician, depending on age, body weight, height, health status, and the body's ability to metabolize and utilize the components of OLIMEL N9E.

Overdose of OLIMEL N9E, infusion emulsion
If an excessive dose is administered or the infusion rate is too high, the amino acids contained in the product may contribute to increased blood acidity and symptoms of hypervolemia (increased circulating blood volume). Blood and urine glucose levels may rise, hyperosmolar syndrome (excessively thick blood) may develop, and lipids contained in the emulsion may increase blood triglyceride levels. Administration of OLIMEL at too high an infusion rate or in excessive volume may cause nausea, vomiting, chills, headache, hot flushes, excessive sweating (hyperhidrosis), and electrolyte disturbances. In such cases, the infusion must be stopped immediately.

In severe cases, the physician may need to subject the patient to temporary kidney dialysis to assist the kidneys in eliminating the excess drug.

To prevent such situations, the physician will regularly monitor the patient's condition and check blood parameters.
If in doubt regarding the use of the medicine, consult a physician.

4. Possible adverse effects

Like all medicines, this medicine can cause adverse effects, although not everyone will experience them.
If you notice any changes in your condition during or after treatment, you should immediately inform your doctor or nurse.
Medical examinations performed during the patient's treatment with this medicine should minimize the risk of adverse effects.
If any unusual signs or symptoms of an allergic reaction occur, such as excessive sweating, fever, chills, headache, skin rash, or breathing difficulties, the infusion must be stopped immediately.

The following adverse effects have been reported during the use of OLIMEL preparation:
Frequency — Common: may affect up to 1 in 10 people

• Increased heart rate (tachycardia);
• Decreased appetite;
• Increased blood lipid levels (hypertriglyceridemia);
• Abdominal pain;
• Diarrhea;
• Nausea;
• Increased arterial blood pressure (hypertension).

Frequency — Unknown: frequency cannot be estimated from the available data

• Hypersensitivity reactions, including sweating, fever, chills, headache, skin rash (erythematous, papular, pustular, macular, generalized rash), itching, hot flushes, breathing difficulties;
• Leakage of infusion into surrounding tissue (extravasation) may lead to pain, irritation, swelling/edema, redness (erythema)/warmth, tissue cell death (skin necrosis), or blisters/vesicles, inflammation, thickening, or tightening of the skin at the infusion site;
• Vomiting.

During the use of similar parenteral nutrition preparations, the following adverse effects have been reported:
Frequency — Very rare: may affect up to 1 in 10,000 people

• Reduced ability to clear lipids (fat overload syndrome) associated with a sudden deterioration in the patient's condition. The fat overload syndrome symptoms listed below usually resolve after stopping the lipid emulsion infusion:
  o Fever
  o Decreased number of red blood cells, which may cause paleness of the skin and lead to weakness or shortness of breath (anemia)
  o Low number of white blood cells, which may increase the risk of infections (leukopenia)
  o Low platelet count, which may increase the risk of bruising and/or bleeding (thrombocytopenia)
  o Coagulation disorders affecting blood clotting ability
  o High blood fat levels (hyperlipidemia)
  o Fatty deposits in the liver (hepatomegaly)
  o Worsening liver function
  o Central nervous system symptoms (e.g. coma).

Frequency — Unknown: frequency cannot be estimated from the available data

• Allergic reactions;
• Abnormal blood test results indicating liver function abnormalities;
• Problems with bile excretion (cholestasis);
• Enlarged liver (hepatomegaly);
• Liver diseases associated with parenteral nutrition (see "Warnings and precautions" in section 2);
• Jaundice;
• Decreased platelet count (thrombocytopenia);
• Increased nitrogen levels in blood (azotemia);
• Elevated liver enzyme activity;
• Formation of small particles that may block blood vessels in the lungs (pulmonary vessel deposits), leading to pulmonary embolism and breathing difficulties (respiratory failure).

Reporting of adverse effects
If any adverse effects occur, including those not listed in this leaflet, you should inform your doctor or nurse. Adverse effects can be reported directly to the Department of Monitoring Adverse Drug Reactions, Office for Registration of Medicinal Products, Medical Devices and Biocidal Products
Al. Jerozolimskie 181C
02-222 Warsaw
Phone: +48 22 49 21 301
Fax: +48 22 49 21 309
Website: https://smz.ezdrowie.gov.pl
Adverse effects can also be reported to the marketing authorization holder.
Reporting adverse effects helps to provide more information on the safety of this medicine.

5. How to store the medicinal product OLIMEL N9E, infusion emulsion

Keep this medicinal product out of sight and reach of children.
Do not use this medicinal product after the expiry date stated on the container and outer packaging (MM/YYYY). The expiry date refers to the last day of the specified month.
Do not freeze.
Store in the original packaging.
Medicinal products must not be disposed of via wastewater or household waste. Ask your pharmacist how to dispose of medicines no longer required. Such measures help protect the environment.

6. Contents of the packaging and other information

What OLIMEL N9E, emulsion for infusion contains
The active substances in each bag of the ready-to-use emulsion are: 14.2% (corresponding to 14.2 g/100 ml)
solution of L-amino acids (alanine, arginine, glycine, histidine, isoleucine, leucine, lysine (as lysine acetate),
methionine, phenylalanine, proline, serine, threonine, tryptophan, tyrosine, valine, aspartic acid, glutamic acid)
with electrolytes (sodium, potassium, magnesium, phosphates, acetates, chlorides),
20% (corresponding to 20 g/100 ml) fat emulsion (purified olive oil and purified soybean oil),
and 27.5% (corresponding to 27.5 g/100 ml) glucose solution (as glucose monohydrate) with calcium.
Other components of the medicine are:

What OLIMEL N9E infusion emulsion looks like and what the packaging contains
OLIMEL is an infusion emulsion supplied in a three-chamber bag. The first chamber contains a fat emulsion, the second chamber contains an amino acid solution with electrolytes, and the third chamber contains a glucose solution with calcium. The chambers are separated from each other by impermeable seals.
Before administration, the contents of each chamber must be mixed by rolling the bag towards itself, starting from the top of the bag, until the seals open.

Appearance before mixing:

• Amino acid and glucose solutions are clear, colourless or slightly yellow.
• The fat emulsion is homogeneous and milky in appearance.

Appearance after mixing: homogeneous milky emulsion.
The 3-chamber bag is a multilayer plastic pouch. The inner (contact) layer of the bag is compatible with the components and permitted additives.
To prevent contact with oxygen in the air, the bag is packed in an oxygen-protective packaging with an oxygen-absorbing sachet.

Packaging sizes:
1000 ml bag: 1 cardboard box containing 6 bags
1500 ml bag: 1 cardboard box containing 4 bags; 1 cardboard box containing 5 bags
2000 ml bag: 1 cardboard box containing 4 bags; 1 cardboard box containing 5 bags
1 bag of 1000 ml, 1500 ml and 2000 ml capacity.
Not all pack sizes may be marketed.

Marketing Authorisation Holder and Manufacturer
Marketing Authorisation Holder
Baxter Polska Sp. z o.o.
Ul. Kruczkowskiego 8
00-380 Warsaw, Poland

Manufacturer
BAXTER S.A.
Boulevard Rene Branquart 80
7860 Lessines, Belgium

This medicinal product is authorised for marketing in the European Economic Area countries under the following names:
France, Portugal, Estonia, Poland, Lithuania, Bulgaria, Romania, Latvia, Czech Republic, Belgium, Spain, Slovakia, Netherlands, Luxembourg, Slovenia, Italy, Greece, Cyprus, Hungary: OLIMEL N9E

In some countries it is registered under a different trade name, as described below:
Austria: ZentroOLIMEL 5,7 % mit Elektrolyten
Germany: Olimel 5,7% E
Denmark, Iceland, Sweden, Norway, Finland: Olimel N9E
United Kingdom, Ireland, Malta: Triomel 9g/l nitrogen 1070 kcal/l with electrolytes

Information intended exclusively for medical professionals:

Pharmacotherapeutic group: parenteral nutrition solutions / mixtures
ATC code: B05 BA10.
A. QUALITATIVE AND QUANTITATIVE COMPOSITION
OLIMEL is provided as a three-chamber bag.
Each bag contains a glucose solution with calcium, a fat emulsion, and an amino acid solution with other electrolytes:

Composition of the ready-to-use emulsion after mixing the contents of the three chambers:

The excipients are:

Nutritional values of the ready-to-use emulsion, according to bag size:

B. DOSAGE AND ADMINISTRATION
Dosage
OLIMEL is not recommended for use in children under 2 years of age due to its unsuitable composition and volume (see sections 4.4; 5.1 and 5.2 of the SmPC).
The maximum daily dose specified below must not be exceeded. Due to the fixed composition of the multi-chamber bag, simultaneous meeting of all the patient's nutritional requirements may not be possible. There may be clinical situations in which patients require different amounts of nutrients than those contained in a fixed-composition bag. In such cases, any change in volume (dose) should take into account the impact on the dosing of all other nutrients in the OLIMEL medicinal product.

Adults
Dosage depends on the patient's energy expenditure, clinical condition, body weight, and ability to metabolize the components of OLIMEL, as well as on energy components or proteins additionally administered orally/enterally; therefore, the appropriate bag size should be selected accordingly.
The average daily requirements are:

• 0.16 to 0.35 g nitrogen/kg body weight (1–2 g amino acids/kg), depending on the patient's nutritional status and degree of catabolism,
• 20 to 40 kcal/kg,
• 20 to 40 ml fluid/kg or 1 to 1.5 ml per kcal consumed.

For the OLIMEL product, the maximum daily dose is defined based on amino acid intake: 35 ml/kg corresponds to 2.0 g amino acids/kg, 3.9 g glucose/kg, 1.4 g lipids/kg, 1.2 mmol sodium/kg, and 1.1 mmol potassium/kg. For a 70 kg patient, this would correspond to 2450 ml of OLIMEL per day, representing an intake of 140 g amino acids, 270 g glucose, and 98 g lipids (i.e., 2058 non-protein kcal and a total of 2622 kcal).

Typically, the infusion rate must be gradually increased during the first hour, and then appropriately adjusted according to the dose, daily volume of the medicinal product administered, and duration of infusion.
For the OLIMEL product, the maximum infusion rate is 1.8 ml/kg/hour, corresponding to 0.10 g amino acids/kg/hour, 0.19 g glucose/kg/hour, and 0.07 g lipids/kg/hour.

Children over 2 years of age and adolescents
Studies have not been conducted in the pediatric population.
Dosage depends on the patient's energy expenditure, clinical condition, body weight, and ability to metabolize the components of OLIMEL, as well as on energy components or proteins additionally administered orally/enterally; therefore, the appropriate bag size should be selected accordingly.
Furthermore, daily requirements for fluids, nitrogen, and energy continuously decrease with age. Two age groups have been considered: 2 to 11 years and 12 to 18 years.
For the OLIMEL N9E product, in the age group 2 to 11 years, the limiting factor for the daily dose is magnesium concentration. In this age group, the limiting factor for the hourly administration rate is glucose concentration. In the age group 12 to 18 years, the limiting factors for the daily dose are amino acid and magnesium concentrations. In this age group, the limiting factor for the hourly administration rate is amino acid concentration. The resulting intake values are presented below:

The rate of administration usually needs to be gradually increased during the first hour, and then adjusted according to the administered dose, daily volume of the medicinal product and duration of the infusion.
In general, in small children it is recommended to start the infusion with a low daily dose and gradually increase it to the maximum dosage (see above).
Method and duration of administration
For single use only.
It is recommended that after opening, the contents of the bag should be used immediately and not stored for subsequent infusions.
After mixing, a homogeneous milky-appearing emulsion is obtained.
Instructions for preparation and use of the infusion emulsion, see section 6.6 of the SmPC.
Due to its high osmolarity, OLIMEL must be administered exclusively via a central vein.
The recommended duration of infusion for the parenteral nutrition bag is 12 to 24 hours.
Parenteral nutrition treatment may be continued as long as clinically indicated.
C. INCOMPATIBILITIES
Do not add any medicinal products or substances to any of the bag components or to the final emulsion without prior confirmation of their compatibility and stability of the resulting product (especially the stability of the fat emulsion).
Incompatibilities may arise, for example, due to excessive acidity (low pH) or inappropriate content of divalent cations (Ca and Mg), which may destabilize the fat emulsion.
As with the preparation of other parenteral nutrition mixtures, the ratio of calcium and phosphate content should be considered. Excessive addition of calcium and phosphate, especially in the form of inorganic salts, may lead to the formation of calcium phosphate precipitates.
OLIMEL contains calcium ions, which pose an additional risk of precipitating clots in blood products or blood components containing citrate as an anticoagulant/preservative.
Ceftriaxone must not be mixed or administered simultaneously with intravenous solutions containing calcium, including OLIMEL, through the same infusion line (e.g. via a Y-connector) due to the risk of precipitation of calcium-ceftriaxone salts (see sections 4.4 and 4.5 of the SmPC). Ceftriaxone and calcium-containing solutions may be administered consecutively if infusion lines are inserted at different sites or are replaced or thoroughly flushed with physiological saline between infusions to prevent precipitation.
Due to the risk of precipitate formation, OLIMEL must not be administered through the same infusion line or mixed with ampicillin or fosphenytoin.
Compatibility with solutions administered simultaneously through the same infusion set, catheter or cannula must be verified.
Due to the risk of pseudoagglutination, this product must not be administered before, during or after blood transfusion through the same infusion set.
D. SPECIAL PRECAUTIONS FOR DISPOSAL AND PREPARATION OF THE MEDICINAL PRODUCT FOR ADMINISTRATION
An overview of the steps for preparing OLIMEL for administration is shown in Figure 1.
Opening
Remove the outer protective bag.
Discard the sachet containing the oxygen absorber.
Ensure that the bag and seals are undamaged. Use only if the bag is intact, seals are unbroken (i.e. the contents of the three compartments have not been mixed), amino acid and glucose solutions are clear, colourless or slightly yellow, practically free from visible particles, and the fat emulsion is homogeneous and milky-appearing.
Mixing of solutions and emulsion
Before breaking the seals, ensure the product is at room temperature.
Starting from the top of the bag (at the handle), roll the bag downwards with both hands. The seals will break progressively from the port side. Continue rolling the bag until the seals are broken halfway along their length.
Mix thoroughly by rotating the bag at least three times.
After mixing, the product forms a homogeneous milky-appearing emulsion.
Additional components
The bag capacity is sufficient to allow addition of vitamins, electrolytes and trace elements.
All additions (including vitamins) should be introduced into the final emulsion (after breaking the seals and mixing the contents of the three compartments).
Vitamins may also be added to the compartment containing glucose prior to preparation of the final emulsion (before breaking the seals and mixing the contents of the three compartments).
When adding components containing electrolytes, the amount of electrolytes already present in the bag must be taken into account.
Additional components must be added by qualified personnel under aseptic conditions.
Electrolytes may be added to the OLIMEL product according to the table below:

Trace elements and vitamins:
Stability has been demonstrated upon addition of commercially available vitamin and trace element products
(containing up to 1 mg of iron).
Compatibility with other additional components is available upon request.
When adding components, the following steps should be taken:

• maintain aseptic conditions,
• prepare the injection site on the bag,
• puncture the injection site and inject the additional components using a syringe needle or a drug preparation device,
• mix the contents of the bag thoroughly after addition of components.

Preparation of infusion
Maintain aseptic conditions.
Hang the bag.
Remove the plastic protective cap from the medication administration port.
Firmly insert the infusion set spike into the medication administration port.
Figure 1. Steps for preparation of OLIMEL for administration.

2. 3.

5. 6.

Administration
For single use only.
Administer the product only after breaking the seals between the 3 compartments and mixing their contents.
Ensure that no phase separation occurs in the final infusion emulsion.
After opening the bag, the contents must be used immediately. Do not store an opened bag for subsequent infusions.
Do not reconnect partially used bags.
To avoid the risk of air embolism caused by gas present in the first bag, do not connect bags in series.
Any unused portion of the product, waste materials, and the entire infusion set must be discarded.

Extravasation
The catheter insertion site should be monitored regularly for signs of extravasation.
In case of extravasation, administration must be stopped immediately, while leaving the inserted catheter or cannula in place to allow immediate initiation of therapeutic measures. If possible, aspirate fluid through the catheter/cannula before removal to reduce the amount of fluid in the tissues.
Depending on the type of extravasated product (including mixed product(s) with OLIMEL, if applicable) and the severity/extent of potential injury, appropriate specific countermeasures should be taken. Therapeutic management options may include non-pharmacological treatment, pharmacological treatment, and/or surgical intervention. In cases of extensive extravasation, consultation with a plastic surgeon should be obtained within 72 hours.
The site of extravasation should be monitored at least every four hours during the first 24 hours, and then once daily.
Infusion should not be resumed into the same central vein.

Baxter and Olimel are trademarks of Baxter International Inc.