(20MMOL/L) POTASSIUM CHLORIDE IN 5% DEXTROSE AND 0.45% SODIUM CHLORIDE INJECTION USP SOLUTION

Canada - English - Health Canada

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Active ingredient:
DEXTROSE; SODIUM CHLORIDE; POTASSIUM CHLORIDE
Available from:
BAXTER CORPORATION
ATC code:
B05BB02
INN (International Name):
ELECTROLYTES WITH CARBOHYDRATES
Dosage:
5G; 450MG; 150MG
Pharmaceutical form:
SOLUTION
Composition:
DEXTROSE 5G; SODIUM CHLORIDE 450MG; POTASSIUM CHLORIDE 150MG
Administration route:
INTRAVENOUS
Units in package:
500/1000ML
Prescription type:
Ethical
Therapeutic area:
REPLACEMENT PREPARATIONS
Product summary:
Active ingredient group (AIG) number: 0300097005; AHFS: 40:12.00
Authorization status:
APPROVED
Authorization number:
00437999
Authorization date:
2012-12-10

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Page 1 of 10

PRESCRIBING INFORMATION

3.3% Dextrose and 0.3% Sodium Chloride Injection

5% Dextrose and 0.2% Sodium Chloride Injection

5% Dextrose and 0.45% Sodium Chloride Injection

5% Dextrose and 0.9% Sodium Chloride Injection

10% Dextrose and 0.9% Sodium Chloride Injection

Dextrose and Sodium Chloride Injection, USP

Solution for infusion

Intravenous Fluid and Nutrient Replenisher

In VIAFLEX Plastic Container

Baxter Corporation

Mississauga, Ontario L5N 0C2

Canada

Date of Revision:

December 14, 2018

Submission Control No: 221959

Baxter and VIAFLEX are Trademarks of Baxter International Inc.

Page 2 of 10

Dextrose and Sodium Chloride Injection, USP

In VIAFLEX Plastic Container

SUMMARY PRODUCT INFORMATION

Dextrose and Sodium Chloride Injection USP solutions are sterile, nonpyrogenic and contain no bacteriostatic or antimicrobial

agents or added buffers. The composition, osmolarity and approximate pH of the individual solutions are shown in Table 1.

Table 1.

Size (mL)

Composition

(g/L)

Osmolarity (mOsmol/L)

Ionic Concentration

(mmol/L)

Caloric Content (cal/L)

Dextrose

Monohyd.

Sodium

Chloride

Sodium

Chloride

3.3% Dextrose & 0.3%

NaCl

00060712

33.0 g

3.0 g

3.5 to 6.5

1000

5% Dextrose & 0.2%

NaCl

00060704

50.0 g

2.0 g

3.5 to 6.5

5% Dextrose & 0.45%

NaCl

00060739

50.0 g

4.5 g

3.5 to 6.5

1000

5% Dextrose & 0.9%

NaCl

00060747

50.0 g

9.0 g

3.5 to 6.5

1000

10% Dextrose & 0.9%

NaCl

1000

00060755

100.0 g

9.0 g

3.5 to 6.5

*The dextrose is purified from corn and may contain fructose.

The VIAFLEX plastic container is fabricated from a specially formulated polyvinyl chloride (PL 146 Plastic).

Water in a solution in the container can permeate through the plastic wall, but in an insufficient amount to significantly affect the

solution. Before the product expires, very small amounts of chemical components of the plastic can be leached into the solution

in the container, such as up to 5 parts per million for di-2-ethylhexyl phthalate (DEHP). No safety issues of the plastic material

were identified in USP biological tests in animals as well as by tissue culture toxicity studies.

ACTIONS

Dextrose and Sodium Chloride Injection USP solutions are a source of water for hydration and provide electrolytes and calories.

Dextrose and Sodium Chloride Injection USP solutions are capable of inducing diuresis depending on the clinical conditions of

the patient. See Table 1 for calories per liter of the various solutions.

Solutions which are di-electrolytic or polyelectrolytic have value in maintaining or replenishing electrolytes. See Table 1 for ionic

concentrations.

Page 3 of 10

INDICATIONS AND CLINICAL USE

Dextrose and Sodium Chloride Injection USP solutions are indicated as a supply of water or for administration of electrolytes or

calories.

CONTRAINDICATIONS

Dextrose and Sodium Chloride Injection, USP is contraindicated in the following conditions:

Patients who are hypersensitive to this drug or to any ingredient in the formulation or component of the container. For a

complete listing, see the SUMMARY PRODUCT INFORMATION section of the Prescribing Information.

Solutions containing dextrose should be used with caution in patients with known allergy to corn or corn products.

Clinically significant hyperglycemia

WARNINGS AND PRECAUTIONS

General

Normal physiologic isotonicity range is approximately 280-310 mOsmol/liter. Administration of substantially hypotonic solutions

may cause hemolysis and administration of substantially hypertonic solutions may cause vein damage.

Dextrose and Sodium Chloride Injection USP solutions should be used with great care, if at all, in patients with congestive heart

failure, severe renal insufficiency, and in clinical states in which there exists edema with sodium retention.

The intravenous administration of Dextrose and Sodium Chloride Injection USP solutions can cause fluid and/or solute

overloading resulting in dilution of serum electrolyte concentrations, overhydration, congested states or pulmonary edema. The

risk of dilutional states is inversely proportional to the electrolyte concentrations of the solutions. The risk of solute overload

causing congested states with peripheral and pulmonary edema is directly proportional to the electrolyte concentrations of the

solutions.

Excessive administration of potassium free solutions may result in significant hypokalemia.

In patients with diminished renal function, administration of solutions containing sodium ions may result in sodium retention.

Hypersensitivity Reactions

Hypersensitivity/infusion reactions, including anaphylaxis, have been reported with Dextrose and Sodium Chloride Injection USP

solutions (see ADVERSE REACTIONS).

Stop the infusion immediately if signs or symptoms of hypersensitivity/infusion reactions develop. Appropriate therapeutic

countermeasures must be instituted as clinically indicated. Appropriate therapeutic countermeasures must be instituted as

clinically indicated.

Solutions containing dextrose should be used with caution in patients with known allergy to corn or corn products.

Hyponatremia

Use in patients at risk for sodium imbalance

Glucose intravenous infusions are usually isotonic solutions. In the body, however, glucose containing fluids can become

extremely physiologically hypotonic due to rapid glucose metabolization.

Monitoring of serum sodium is particularly important for hypotonic fluids. See Table 1 for information on the products’ osmolarity.

Depending on the tonicity of the solution, the volume and rate of infusion, and depending on a patient’s underlying clinical

condition and capability to metabolize glucose, intravenous administration of glucose can cause electrolyte disturbances, most

importantly hypoosmotic or hyperosmotic hyponatremia.

Page 4 of 10

High volume infusion must be used under specific monitoring in patients with cardiac or pulmonary failure, and in patients with

non-osmotic vasopressin release (including syndrome of inappropriate antidiuretic hormone secretion (SIADH), due to the risk of

hospital-acquired hyponatremia.

Dextrose and Sodium Chloride Injection USP solutions should be used with particular caution, in patients with or at risk for

hyponatremia is increased, for example,

in children

in elderly patients

in women

postoperatively

in persons with psychogenic polydipsia

in patients treated with medications that increase the risk of hyponatremia (See DRUG INTERACTIONS)

The risk for developing hyponatremic encephalopathy is increased (applies to solutions containing less than 0.9% sodium

chloride), for example,

in pediatric patients (≤16 years of age)

in women (in particular, premenopausal women)

in patients with hypoxemia

in patients with underlying central nervous system disease.

Acute hyponatremia can lead to acute hyponatremic encephalopathy (brain edema) characterized by headache, nausea,

seizures, lethargy and vomiting. Patients with brain edema are at particular risk of severe, irreversible and life-threatening brain

injury.

Clinical evaluation and periodic laboratory determinations may be necessary to monitor changes in fluid balance, electrolyte

concentrations, and acid-base balance during prolonged parenteral therapy or whenever the condition of the patient or the rate of

administration warrants such evaluation.

Use in patients at risk for sodium retention, fluid overload and edema

Dextrose and Sodium Chloride Injection USP solutions should be used with particular caution, in patients with or at risk for:

Hypernatremia (applies to solutions containing 0.9% sodium chloride)

Hyperchloremia (applies to solutions containing 0.9% sodium chloride)

Metabolic acidosis (applies to solutions containing 0.9% sodium chloride)

Hypervolemia

Conditions that may cause sodium retention, fluid overload and edema (central and peripheral), such as patients with

primary hyperaldosteronism,

secondary hyperaldosteronism associated with, for example,

hypertension,

congestive heart failure,

liver disease (including cirrhosis),

renal disease (including renal artery stenosis, nephrosclerosis)

pre-enclampsia.

Medications that may increase the risk of sodium and fluid retention, such as corticosteroids.

Hypokalemia

The infusion of Dextrose and Sodium Chloride Injection USP solutions may result in hypokalemia.

Dextrose and Sodium Chloride Injection USP solutions should be used with particular caution in patients with or at risk for

hypokalemia, close clinical monitoring may be warranted, for example:

in persons with metabolic alkalosis

Page 5 of 10

in persons with thyrotoxic periodic paralysis, administration of intravenous dextrose has been associated in

aggravating hypokalemia

in persons with increased gastrointestinal losses (e.g. diarrhea, vomiting)

prolonged low potassium diet

in persons with primary hyperaldosteronism

in patients treated with medications that increase the risk of hypokalemia (e.g. diuretics, beta-2 agonist, or insulin)

Risk of hypoosmolality and hyperosmolality, serum electrolytes and water imbalance

Depending on the volume and rate of infusion and depending on a patient’s underlying clinical condition and capability to

metabolize dextrose, intravenous administration of Dextrose and Sodium Chloride Injection USP solutions can cause:

Hyperosmolality, osmotic diuresis and dehydration

Hypoosmolality (applies to solutions containing less than 0.9% sodium chloride)

Electrolyte disturbances such as

Hyponatremia, (see Hyponatremia and Use in patients at risk for sodium imbalance)

Hypokalemia,

Hypophosphatemia,

Hypomagnesemia,

Overhydration/hypervolemia and, for example, congested states, including central (e.g. pulmonary congestion) and

peripheral edema.

Acid-base imbalance (applies to solutions containing 0.9% sodium chloride)

An increase in serum glucose concentration is associated with an increase in serum osmolality. Osmotic diuresis

associated with hyperglycemia can result in or contribute to the development of dehydration and in electrolyte losses.

Clinical evaluation and periodic laboratory determinations may be necessary to monitor changes in fluid balance, electrolyte

concentrations, and acid-base balance during prolonged parenteral therapy or whenever the condition of the patient or the

rate of administration warrants such evaluation.

Hyperglycemia

Rapid administration of dextrose solutions may produce substantial hyperglycemia and hyperosmolar syndrome.

In order to avoid hyperglycemia the infusion rate should not exceed the patient’s ability to utilize glucose.

To reduce the risk of hyperglycemia-associated complications, the infusion rate must be adjusted and/or insulin administered if

blood glucose levels exceed levels considered acceptable for the individual patient.

Intravenous dextrose should be administered with caution in patients with, for example:

impaired glucose tolerance (such as in diabetes mellitus, renal impairment, or in the presence of sepsis, trauma, or

shock),

severe malnutrition (risk of precipitating a refeeding syndrome),

thiamine deficiency, e.g., in patients with chronic alcoholism (risk of severe lactic acidosis due to impaired oxidative

metabolism of pyruvate),

water and electrolyte disturbances that could be aggravated by increased glucose and/or free water load

Other groups of patients in whom Dextrose and Sodium Chloride Injection USP solutions should be used with caution include:

patients with ischemic stroke. Hyperglycemia has been implicated in increasing cerebral ischemic brain damage and

impairing recovery after acute ischemic strokes.

Page 6 of 10

patients with severe traumatic brain injury (in particular during the first 24 hours following the trauma). Early

hyperglycemia has been associated with poor outcomes in patients with severe traumatic brain injury.

Newborns (See Pediatric glycemia-related issues).

Prolonged intravenous administration of dextrose and associated hyperglycemia may result in decreased rates of glucose-

stimulated insulin secretion.

Refeeding Syndrome

Refeeding severely undernourished patients may result in the refeeding syndrome that is characterized by the shift of potassium,

phosphorus, and magnesium intracellularly as the patient becomes anabolic. Thiamine deficiency and fluid retention may also

develop. Careful monitoring and slowly increasing nutrient intakes while avoiding overfeeding can prevent these complications.

Use in Patients with or at risk of Severe Renal Impairment

Dextrose and Sodium Chloride Injection USP solutions should be administered with particular caution, to patients with or at risk

of (severe) renal impairment. In such patients, administration of Dextrose and Sodium Chloride Injection USP solutions may

result in sodium retention and/or fluid overload.

Blood

Dextrose and Sodium Chloride Injection USP solutions should not be administered simultaneously with blood through the same

administration set because of the possibility of pseudoagglutination (for solutions with Dextrose more or equal to 5%) or

hemolysis.

Risk of Air Embolism

Do not connect flexible plastic containers in series in order to avoid air embolism due to possible residual air contained in the

primary container.

Pressurizing intravenous solutions contained in flexible plastic containers to increase flow rates can result in air embolism if the

residual air in the container is not fully evacuated prior to administration.

Use of a vented intravenous administration set with the vent in the open position could result in air embolism. Vented intravenous

administration sets with the vent in the open position should not be used with flexible plastic containers.

SPECIAL POPULATIONS

Pregnancy and Lactation

It is not known whether this drug is excreted in human milk. Because many drugs are excreted in human milk, caution should be

exercised when Dextrose and Sodium Chloride Injection, USP is administered to a nursing mother.

Intrapartum maternal intravenous dextrose infusion may result in fetal hyperglycemia and metabolic acidosis as well as rebound

neonatal hypoglycemia due to fetal insulin production.

Healthcare practitioners should carefully consider the potential risks and benefits for each specific patient before administering

Dextrose and Sodium Chloride Injection, USP solutions.

Pediatrics

The infusion rate and volume depends on the age, weight, clinical and metabolic conditions of the patient, concomitant therapy

and should be determined by the consulting physician experienced in pediatric intravenous fluid therapy. Plasma electrolyte

Page 7 of 10

concentrations should be closely monitored in the pediatric population as this population may have impaired ability to regulate

fluids and electrolytes.

The infusion of hypotonic fluids (applies to solutions containing less than 0.9% sodium chloride) together with the non-osmotic

secretion of Antidiuretic hormone (ADH) may result in hyponatremia.

Pediatric Glycemia-related Issues

Newborns especially those born premature and with low birth weight - are at increased risk of developing hypo- or

hyperglycemia. Close monitoring during treatment with intravenous dextrose solutions is needed to ensure adequate glycemic

control, in order to avoid potential long term adverse effects.

Hypoglycemia in the newborn can cause, e.g.,

prolonged seizures,

coma, and

cerebral injury, including brain damage.

Hyperglycemia has been associated with

cerebral injury, including intraventricular hemorrhage,

late onset bacterial and fungal infection,

retinopathy of prematurity,

necrotizing enterocolitis,

increased oxygen requirements,

prolonged length of hospital stay, and

death.

Pediatric Hyponatremia-related Issues

Children (including neonates and older children) are at increased risk of developing hyponatremia as well as for developing

hyponatremic encephalopathy.

The infusion of hypotonic fluids together with the non-osmotic secretion of ADH may result in hyponatremia (applies to solutions

containing less than 0.9% sodium chloride).

Acute hyponatremia can lead to acute hyponatremic encephalopathy (brain edema) characterized by headache, nausea,

seizures, lethargy and vomiting. Patients with brain edema are at particular risk of severe, irreversible and life-threatening brain

injury.

Plasma electrolyte concentrations should be closely monitored in the pediatric population.

Rapid correction of hyponatremia is potentially dangerous (risk of serious neurologic complications). Dosage, rate, and duration

of administration should be determined by a physician experienced in pediatric intravenous fluid therapy.

Geriatrics

When selecting the type of infusion solution and the volume/rate of infusion for a geriatric patient, consider that geriatric patients

are generally more likely to have cardiac, renal, hepatic, and other diseases or concomitant drug therapy. In general, dose

selection for an elderly patient should be cautious, usually starting at the low end of the dosing range.

ADVERSE REACTIONS

Reactions which may occur because of the solution or the technique of administration include febrile response, infection at the

site of injection, venous thrombosis or phlebitis extending from the site of injection, extravasation, and hypervolemia.

If any adverse reaction does occur, discontinue the infusion, evaluate the patient, institute appropriate therapeutic

countermeasure, and save the remainder of the fluid and administration set for examination if deemed necessary.

Page 8 of 10

Other Adverse Reactions (Class Reactions)

Other adverse reactions reported with other similar products include:

Hyponatremia, which may be symptomatic (applies to solutions containing 0.9% sodium chloride)

Hyponatremic encephalopathy

Acidosis Hyperchloraemic (applies to solutions containing 0.9% sodium chloride)

Post-Marketing Adverse Reactions

The following adverse reactions have been reported in post-marketing experience:

IMMUNE SYSTEM DISORDERS: Anaphylactic reaction, Hypersensitivity

METABOLISM AND NUTRITION DISORDERS: Hyponatremia (applies to solutions containing less than 0.9% sodium chloride),

Hypernatremia (applies to solutions containing 0.9% sodium chloride), Hyperglycemia

VASCULAR DISORDERS: Phlebitis

SKIN AND SUBCUTANEOUS TISSUE DISORDERS: Rash, Pruritus

GENERAL DISORDERS AND ADMINISTRATION SITE CONDITIONS: Injection site reactions including: Infusion site pain,

Injection site vesicles, chills, pyrexia

DRUG INTERACTIONS

Both the glycemic effects of Dextrose and Sodium Chloride Injection USP solutions and its effects on water and electrolyte

balance should be taken into account when using Dextrose and Sodium Chloride Injection USP solutions in patients treated with

other substances that affect glycemic control, or fluid and/or electrolyte balance.

Caution is advised in patients treated with lithium. Renal sodium and lithium clearance may be increased during administration of

Dextrose and Sodium Chloride Injection USP solutions and can result in decreased lithium levels.

Caution is advised when administering Dextrose and Sodium Chloride Injection USP solutions to patients treated with drugs

leading to an increased vasopressin effect. The below listed drugs increase the vasopressin effect, leading to reduced renal

electrolyte free water excretion and may increase the risk of hyponatremia following treatment with intravenous fluids. (See

WARNINGS AND PRECAUTIONS and ADVERSE REACTIONS).

Drugs stimulating vasopressin release such as chlorpropamide, clofibrate, carbamazepine, vincristine, selective

serotonin reuptake inhibitors (SSRIs),

3.4-methylenedioxy-N-methamphetamine, ifosfamide, antipsycotics, opioids.

Drugs potentiating vasopressin action such as chlorpropamide, non steroidal anti-inflammatories (NSAIDS),

cyclophosphamide.

Vasopressin analogues such as desmopressin, oxytocin, vasopressin, terlipressin.

Caution is advised when administering Dextrose and Sodium Chloride Injection USP to patients treated with drugs that may

increase the risk of hyponatremia, such as diuretics and antiepileptics (e.g., oxcarbazepine).

Regarding medications that increase the risk of sodium and fluid retention, see WARNINGS AND PRECAUTIONS

DOSAGE AND ADMINISTRATION

As directed by a physician. The choice of the specific sodium chloride and dextrose concentrations, dosage, volume, rate and

duration of administration depend on the age, weight and clinical condition of the patient and concomitant therapy, and

administration should be determined by a physician. For patients with electrolyte and glucose abnormalities and for pediatric

patients, consult a physician experienced in intravenous fluid therapy. All Dextrose and Sodium Chloride Injection USP solutions

in VIAFLEX plastic containers are intended for intravenous infusion using sterile equipment. It is recommended that intravenous

administration apparatus be replaced at least once every 24 hours.

Use of an in-line filter is recommended during administration of all parenteral solutions where possible.

Hyperosmolar solutions may cause venous irritation and phlebitis. Thus, any hyperosmolar solutions are recommended to be

administered through a large central vein, for rapid dilution of the hypertonic solution. See Table 1 for information on the

products’ osmolarity.

Page 9 of 10

For solutions containing 10% Dextrose, the osmolarity of a final admixed solution must be taken into account when peripheral

administration is considered.

Rapid correction of hyponatremia and hypernatremia is potentially dangerous (risk of serious neurologic complications). Dosage,

rate, and duration of administration should be determined by a physician experienced in intravenous fluid therapy.

A gradual increase of flow rate should be considered when starting administration of dextrose-containing products.

Electrolyte supplementation may be indicated according to the clinical needs of the patient.

Additives may be incompatible. Compatibility of additives must be checked before adding medication. Those additives known or

determined to be incompatible should not be used. When introducing additives to Dextrose and Sodium Chloride Injection USP

solutions, the instructions for use of the medication to be added and other relevant literature must be consulted.

If in the informed judgment of the physician it is deemed advisable to introduce additives, use aseptic technique.

Before adding a substance or medication, verify that it is soluble in and/or stable in Dextrose and Sodium Chloride Injection USP

solutions and that the pH range of Dextrose and Sodium Chloride Injection USP solutions is appropriate.

After addition, check for a possible color change and/or the appearance of precipitates, insoluble complexes or crystals.

Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever

solution and container permit. Do not administer unless the solution is clear and the seal is intact.

Use of an in-line filter is recommended during administration of all parenteral solutions where possible.

Thorough and careful mixing of any additive is mandatory. Do not store solutions containing additives.

For single use only.

Discard any unused portion.

OVERDOSAGE

Excess administration of Dextrose and Sodium Chloride Injection USP solutions can cause:

hyperglycemia, adverse effects on water and electrolyte balance, and corresponding complications. For example,

severe hyperglycemia and severe dilutional hyponatremia, and their complications, can be fatal.

hyponatremia (which can lead to CNS manifestations, including seizures, coma, cerebral edema and death).

hypernatremia especially in patients with severe renal impairment (applies to solutions containing 0.9% sodium

chloride).

Fluid overload (which can lead to central and/or peripheral edema).

See also WARNINGS AND PRECAUTIONS and ADVERSE REACTIONS sections

When assessing an overdose, any additives in the solution must also be considered.

Clinically significant overdose of Dextrose and Sodium Chloride Injection USP solutions may, therefore, constitute a medical

emergency.

Interventions include discontinuation of Dextrose and Sodium Chloride Injection USP solutions administration, dose reduction,

administration of insulin and other measures as indicated for the specific clinical constellation.

DOSAGE FORMS, COMPOSITION AND PACKAGING

How Supplied

Table 1 shows the composition, osmolarity, approximate pH, and ionic concentration of Dextrose and Sodium Chloride

Injections.

Dextrose and Sodium Chloride Injection products are packaged in the Viaflex plastic container which is fabricated from a

specially formulated polyvinyl chloride (PL 146 Plastic).

Page 10 of 10

The available package sizes of Dextrose and Sodium Chloride Injection products are listed in Table 2.

Table 2. Package sizes of Dextrose and Sodium Chloride Injection products

Product

Package size

3.3% Dextrose and 0.3% Sodium Chloride Injection

500mL, 1000mL

5% Dextrose and 0.2% Sodium Chloride Injection

500mL

5% Dextrose and 0.45% Sodium Chloride Injection

500mL, 1000mL

5% Dextrose and 0.9% Sodium Chloride Injection

500mL, 1000mL

10% Dextrose and 0.9% Sodium Chloride Injection

1000mL

Directions for use of VIAFLEX Plastic Container

WARNING: Do not use plastic containers in series connections. Such use could result in air embolism due to residual air

(approximately 15 mL) being drawn from the primary container before administration of the fluid from the secondary container is

completed.

Do not remove unit from overwrap until ready to use.

To Open

Tear overwrap down side at slit and remove solution container. Visually inspect the container. If the outlet port protector is

damaged, detached, or not present, discard container as solution path sterility may be impaired. If supplemental medication is

desired, follow directions below before preparing for administration. Some opacity of the plastic due to moisture absorption

during sterilization process may be observed. This is normal and does not affect the solution quality and safety. The opacity will

diminish gradually. Check for minute leaks by squeezing inner bag firmly. If leaks are found discard solution as sterility may be

impaired.

Preparation for Administration

Suspend container from eyelet support.

Remove plastic protector from outlet port at bottom of container.

Attach administration set. Refer to complete directions accompanying set.

To Add Medication

1. Prepare medication site.

2. Using a syringe and 20 - 22 gauge needle, puncture resealable rubber plug at target area and inject. Multiple additions may

be made in this manner.

3. Mix solution and medication thoroughly. For high density medications such as potassium chloride, squeeze ports while ports

are upright and mix thoroughly.

Storage

Store at 15°C to 25°C

Baxter Corporation

Mississauga, ON L5N 0C2

Baxter and VIAFLEX are trademarks of Baxter International Inc.

Last revised: December 14, 2018

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