1.5% GLYCINE IRRIGATION SOLUTION USP Irrigation/Solution for

What is 1.5% GLYCINE IRRIGATION SOLUTION USP

1.5% Glycine Irrigation Solution U.S.P. is a sterile, non-electrolyte, non-hemolytic solution intended for urologic irrigation during surgical procedures. It contains 1.5 grams of glycine per 100 mL of water, making it a hypotonic solution. This irrigation fluid is commonly used during transurethral surgical procedures such as transurethral resection of the prostate (TURP), where an electrically conductive-free environment is required.

• Form: Irrigation/Solution for sterile use only.
• Volume: Supplied in 2000 ml plastic bags for continuous flow.
• Generic Name: Glycine 1.5% Irrigation Solution.
• Category: Surgical irrigation fluid, non-electrolyte.
• Indications: Primarily used for irrigating the urinary bladder, urethra, and during urological endoscopic procedures.
• Key Properties: It is clear, colorless, and free from particles, with a slightly sweet taste due to glycine content.

Glycine, being a naturally occurring amino acid, is minimally absorbed during procedures. However, excessive systemic absorption can occur in prolonged surgeries, necessitating careful monitoring.

How to use 1.5% GLYCINE IRRIGATION SOLUTION USP

1.5% Glycine Irrigation Solution is designed for use by trained medical professionals during specific surgical procedures. It is not intended for intravenous administration or general therapeutic use.

• Administration Route: Intraoperative irrigation only via endoscopic surgical systems.
• Environment: Must be used in a sterile, controlled operating room under aseptic conditions.
• Equipment: Delivered through gravity-fed systems or closed irrigation systems connected to surgical instruments.
• Setup: Suspend the 2000 ml plastic bag above the patient to allow gravity-assisted flow. Ensure all connections are secure and sterile.
• Flow Regulation: Adjust the clamp or valve to control flow rate according to the surgeon’s requirement.
• Warming: If necessary, warm the solution to body temperature to reduce discomfort and hypothermia risk.
• Visual Inspection: Check for clarity and integrity of the bag before use. Do not use if the solution is discolored or the container is damaged.

Avoid prolonged or excessive use, and monitor fluid balance and serum electrolytes if a large volume is used. Discard any unused solution after procedure.

Mode of Action 1.5% GLYCINE IRRIGATION SOLUTION USP

The primary role of 1.5% Glycine Irrigation Solution is mechanical — it serves as a lavage fluid to clear blood, tissue debris, and clots from the surgical site. However, its formulation also carries physiological importance.

• Non-Conductive Medium: It provides a non-electrolyte solution that allows safe use with monopolar electrosurgical instruments, minimizing electrical conduction to surrounding tissues.
• Hypotonic Nature: Being hypotonic, it may be absorbed into the bloodstream during procedures, but is generally well-tolerated in limited volumes.
• Metabolic Role: Glycine, a non-essential amino acid, may act as an inhibitory neurotransmitter in the central nervous system, though such effects are rare during normal use.
• Low Hemolytic Risk: Its composition minimizes the risk of red blood cell lysis compared to distilled water, making it safer for prolonged irrigation.

Its action is not pharmacologic in nature but is critical in enabling clear visualization and safe surgical intervention, particularly in the urinary tract. Systemic effects may arise with absorption, so hemodynamic parameters should be monitored during extensive procedures.

1.5% GLYCINE IRRIGATION SOLUTION USP Interactions 1.5% GLYCINE IRRIGATION SOLUTION USP

Although 1.5% Glycine Irrigation Solution is not intended for systemic administration, absorption may occur, especially during prolonged or extensive urological procedures. Therefore, awareness of potential interactions is important.

• Diuretics: Concomitant use may increase the risk of fluid imbalance, particularly hyponatremia or fluid overload.
• Electrolyte Supplements: Use with electrolyte-containing solutions or supplements should be monitored to avoid dilutional hyponatremia.
• General Anesthetics: Some anesthetic agents may potentiate central nervous system depression in the rare event of glycine absorption and systemic distribution.
• Nephrotoxic Drugs: Patients on aminoglycosides or NSAIDs may be at increased risk of renal stress if fluid absorption leads to volume overload.
• Antihypertensives: Unexpected fluid absorption can affect blood pressure and interact with antihypertensive medication regimens.

Since the solution is not typically absorbed in significant amounts, interactions are rare and mostly clinical rather than biochemical. Monitor patients with cardiac, hepatic, or renal impairments closely if absorption is suspected.

Dosage of 1.5% GLYCINE IRRIGATION SOLUTION USP

The dosage of 1.5% Glycine Irrigation Solution is not standardized in terms of volume, as it is guided by procedural requirements and surgical technique. It is used as needed to maintain a clear visual field during endoscopic procedures.

• Usual Volume: Anywhere between 2000 ml to 10,000 ml may be used per procedure, depending on surgical duration and bleeding.
• Maximum Volume: Should be based on patient tolerance and monitored fluid absorption.
• Flow Rate: Adjusted intraoperatively by the surgical team to provide adequate visibility without overdistending the bladder or causing tissue trauma.
• Frequency: Single-use only during a surgical procedure. Not for repeat administration.
• Patient Factors: Lower volumes may be necessary in patients with renal, cardiac, or hepatic impairment.

The solution is for **irrigation only** and must **never** be administered intravenously. Always monitor patient vitals during extended surgical procedures involving large irrigation volumes.

Possible side effects of 1.5% GLYCINE IRRIGATION SOLUTION USP

Although 1.5% Glycine is used externally during procedures, some systemic absorption can occur, especially in long surgeries or when mucosal barriers are disrupted. This may result in a range of side effects.

• Electrolyte Imbalance: Dilutional hyponatremia is the most common risk, especially during TURP procedures.
• Fluid Overload: May cause pulmonary edema, hypertension, or heart failure in susceptible individuals.
• Visual Disturbances: Blurred vision and temporary blindness due to high serum glycine levels (rare).
• Nausea and Vomiting: As a result of CNS glycine effects.
• Confusion or Drowsiness: Signs of TURP syndrome due to excessive absorption.
• Allergic Reactions: Rare but may include rash, itching, or hypersensitivity.

Most side effects are avoidable with proper surgical technique and monitoring. Immediate medical attention is needed if signs of glycine toxicity or fluid overload occur.

1.5% GLYCINE IRRIGATION SOLUTION USP Contraindications 1.5% GLYCINE IRRIGATION SOLUTION USP

While generally safe when used correctly, 1.5% Glycine Irrigation Solution is contraindicated in specific conditions or patient profiles.

• Intravenous Use: Absolutely contraindicated. Not for IV, subcutaneous, or intramuscular administration.
• Severe Renal Impairment: Risk of fluid retention and reduced glycine clearance.
• Congestive Heart Failure: May exacerbate volume overload and cardiac stress.
• Known Hypersensitivity: Avoid in patients with previous allergic reaction to glycine or packaging components.
• Unmonitored Procedures: Should not be used in surgical settings lacking appropriate equipment to monitor fluid absorption and patient status.

Caution is advised in patients with electrolyte imbalance, hepatic impairment, or any condition that predisposes them to fluid overload.

Storage of 1.5% GLYCINE IRRIGATION SOLUTION USP

Proper storage is critical to ensure the sterility and effectiveness of 1.5% Glycine Irrigation Solution U.S.P. Adhere to the following storage recommendations to maintain product quality.

• Temperature: Store between 15°C to 30°C (59°F to 86°F).
• Freezing: Do not freeze. If the solution is accidentally frozen, discard it.
• Light Exposure: Protect from prolonged exposure to direct sunlight.
• Packaging Integrity: Do not use if the plastic bag is damaged, leaking, or if the solution appears cloudy or contains particulates.
• Shelf Life: Refer to the expiration date printed on the packaging. Do not use after expiry.
• After Opening: For single-use only. Discard any unused portion immediately after use to prevent contamination.

Ensure the storage area is clean, dry, and away from potential contaminants. Keep out of reach of unauthorized personnel.