Arrangement and method for providing a formulation for parenteral nutrition

Abstract

The invention relates to an arrangement and a method for preparing a formulation for parenteral nutrition. In more detail the invention relates to a mixing system for parenteral nutrition, comprising at least two containers, wherein the at least two containers form a modular system. The mixing system comprises a septum, which is pierceable by a spike or a needle and a hanger for attaching the mixing system to an infusion rack. A first container comprises a male connector and a second container comprises a female connector, which fit together. First and second container can be coupled together, thereby forming a channel, which enables the passage of liquid and the mixing of the ingredients of the containers.

Claims

1. A mixing system for parenteral nutrition, said mixing system comprising at least two containers that form a modular system, said at least two containers comprising a first container filled with a first liquid for parenteral nutrition and a second container filled with a second liquid for parenteral nutrition, wherein said mixing system further comprises a septum and a hanger, wherein said septum is pierceable by a spike or a needle, wherein said hanger is configured for attaching said mixing system to an infusion rack, wherein said first container comprises a male connector and said second container comprises a female connector that fits said male connector, wherein said first and second containers are configured to be coupled together by connecting said male and female connectors so as to form a channel that enables passage of liquid, said channel permitting mixing of said first and second liquids.

2. The mixing system of claim 1, wherein said at least two containers comprises a third container, wherein said first container contains amino acids, said second container contains glucose, and said third container contains fat.

3. The mixing system of claim 1, wherein said first container further comprises a female connector and said second container comprises a male connector that fits said female connector.

4. The mixing system of claim 1, wherein said at least two containers comprise a locking device for engaging a sealed non-detachable connection between said at least two containers, thereby forming a pre-assembled mixing system.

5. The mixing system of claim 4, wherein said locking device is configured to engage said non-detachable connection before formation of said channel.

6. The mixing system of claim 4, wherein said locking device is configured to provide an optical and/or acoustic signal when said containers are non-detachably connected and/or when said containers are non-detachably locked after forming said channel.

7. The mixing system of claim 1, wherein said containers are not-detachably locked when said channel is formed.

8. The mixing system of claim 1, wherein one of said first and second containers comprises said hanger and wherein said hanger is mounted in an area of said male or female connector.

9. The mixing system of claim 1, wherein said containers are blow-molded plastic containers.

10. The mixing system of claim 1, wherein said containers are coupled together by less than one turn of a screw.

11. The mixing system of claim 1, further comprising one of an ampoule and vial holder that is connectable to one of said first and second containers and a cartridge filled with a powdered ingredient, the cartridge being configured to be connected to said female connector.

12. The mixing system of claim 1, wherein said at least two containers are pre-assembled and inserted into a secondary package, wherein said secondary package comprises an oxygen diffusion barrier.

13. The mixing system of claim 1, wherein said make and female connectors are sealed with detachable tamper-evident closures.

14. The mixing system of claim 1, wherein at least one of said containers comprises a housing, wherein said housing is a bellows.

15. The mixing system of claim 1, wherein said septum is provided in one of said male and female connectors and wherein said septum comprises a connector that is configured for connection to said one of said male and female connectors.

16. The mixing system of claim 1, further comprising a membrane-breaker insert, said insert being a separate component that is placed between said male connector and said female connector.

Description

BRIEF DESCRIPTION OF THE DRAWINGS

(1) The invention is shown in more detail referring to certain embodiments according to the drawings FIG. 1 to FIG. 27.

(2) FIG. 1 is a perspective view of a mixing system according to an embodiment of the invention.

(3) FIG. 2 and FIG. 3 are perspective views of a cartridge, which comprises a powder, e.g. a pharmaceutical powder or a micro nutrition, which can be used for the mixing system.

(4) FIG. 4 and FIG. 5 are perspective views of one container of the mixing system.

(5) FIG. 6 shows a further container of the mixing system, which comprises a hanger.

(6) FIG. 7 is a perspective view of a mixing system, which is equipped with a vial holder.

(7) FIG. 8 is a perspective view of the vial holder.

(8) FIG. 9 is a cut-away view of two containers of the mixing system.

(9) FIG. 10 is a detailed view of FIG. 9 showing the area of a membrane breaker insert.

(10) FIG. 11 is a perspective view of a container comprising a membrane breaker insert.

(11) FIG. 12 is a cut-away view of the container.

(12) FIG. 13 and FIG. 14 are perspective views of the membrane breaker insert. FIG. 14a is a detailed view of FIG. 14

(13) FIG. 15 is a further cut-away view of the container.

(14) FIG. 16 is a detailed view of the area of the male connector of the container.

(15) FIG. 17 is a detailed view of FIG. 16 showing the edge of the sidewall of the housing of the container.

(16) FIG. 18 is an exploded cut-away assembly drawing.

(17) FIG. 19 and FIG. 20 are further cut-away views of two containers, which illustrate that a channel, which enables the passage a liquid, is formed, when the containers are connected.

(18) FIG. 21 is a cut-away view showing the open channel between the containers.

(19) FIG. 22 is a sectional view of a further embodiment of a container, which is embodied as a bellows.

(20) FIG. 23 and FIG. 24 show the components of a locking devise, according to an embodiment of the invention.

(21) FIG. 25 is a schematic drawing of a preassembled mixing system, which is arranged in a secondary package.

(22) FIG. 26 is a sectional view of a container, which is equipped with a modular septum.

(23) FIG. 26a is a perspective view of a container, which is equipped with a modular septum.

(24) FIG. 27 is a flow chart of a method to mix parenteral nutrition according to an embodiment of the invention.

DETAILED DESCRIPTION OF THE DRAWINGS

(25) FIG. 1 is a perspective view of an embodiment of a mixing system 1 according to the invention.

(26) In this embodiment, the mixing system 1 comprises the three containers 2a-2c.

(27) As an example each of these containers 2a-2c has a different size in comparison to the other containers 2a-2c.

(28) In this embodiment, the containers 2a-2c have a cylindrical shape and are connected in series. Preferably, the housings of the containers 2a-2c have a diameter between 5 and 10 cm. Each container preferably has an inner volume between 50 and 500 ml.

(29) The containers 2a-2c consist of a plastic material, preferably of a polypropylene.

(30) According to an embodiment of the invention, the containers 2a-2c comprise, for instance are coated with, an oxygen-barrier coating, e.g. a deposited glass or metal layer or an EVOH-layer.

(31) The housing of the containers 2a-2c can comprise an integrally molded batch number and/or label (not shown).

(32) The sidewall of the containers 2a-2c comprise markings 44 (embodied as arrows). As shown, the markings of the respective containers 2a-2c are positioned on one line. In this condition, the containers 2a-2c are non-twistably locked. There is already formed a channel 23 between the containers 2a-2c, which enables the passage of liquid.

(33) The topmost container 2c comprises a hanger 3 to attach the mixing system 1 to an infusion rack (not shown).

(34) In this embodiment, the hanger 3 is a component of the topmost container 2c.

(35) The undermost container 2a comprises the free or non-connected male connector 5 of the mixing system 1. The male connector 5 of this container 2a provides an exposed septum 32 into which a spike or needle can be inserted.

(36) The female connector 6 of the topmost container 2c is here additionally equipped or loaded with a cartridge 4, which can comprise a solid ingredient, e.g. a pharmaceutical powder.

(37) FIG. 2 and FIG. 3 are perspective views of the cartridge 4.

(38) The cartridge 4 is preferably embodied as a molded plastic part.

(39) As shown in FIG. 2, the cartridge 4 comprises a thread 7 and a grip 8 which can be used to screw the cartridge 4 into a female connector 6, here into the female connector 6 of the topmost container 2c.

(40) The thread 7 comprises two segments, which are arranged on opposite sidewalls of the cartridge 4. The segments of the thread 7 can be inserted into corresponding notches 11 of the female connector 6. The cartridge 4 can be connected with the female connector 6 of the topmost container 2c, preferably by turning the cartridge 4 less than one turn, most preferably by turning a half turn or less (see for instance FIG. 4).

(41) As shown in FIG. 3, the cartridge 4 comprises a collar 10 at its upper side.

(42) The bottom side of the cartridge 4 comprises a membrane 9, which preferably opens automatically, when connecting the cartridge 4 to the female connector 6. Thereby, the pharmaceutical ingredient (not shown) can enter into the respective container 2, 2a-2d, and can be mixed with the liquid ingredient of at least one further container 2, 2a-2c.

(43) FIG. 4 and FIG. 5 are perspectives views of a container 2, which is or can be one component of the mixing system 1 shown in FIG. 1.

(44) At opposite ends the container 2 comprises a male connector 5 and a female connector 6. The female connector 6 comprises at least two notches 11. The notches 11 are embodied to receive the at least two segments of the thread 7 of the male connector 5 of another container 2, 2a-2d.

(45) The male connector 5 and female connector 6 of the container 2, and of the further containers 2a-2d of the mixing system 1 fit together. Therefore, the containers 2, 2a-2d, can be connected in various orders.

(46) The male 5 and/or female connector 6 is/are preferably integrally molded. According to another embodiment, the male connector 5 and the female connector 6 can also be welded or glued to the housing.

(47) The containers 2a-2d filled with a liquid for parenteral nutrition are preferably produced in an aseptic blow-fill-seal process. Alternatively, also a stretch-blow-mold process can be used.

(48) The notches 11 turn into a female thread 47, which is suitable for engaging the thread 7 of the male connector 5. To connect a container 2, 2a-2d to another container 2, 2a-2d, the male connector 5 is inserted into the female connector 6 by an axial movement. The segments of the thread 7 engage into the notches 11. Then, the containers 2, 2a-2d are twisted and the segments of the thread 7 are engaged in the corresponding segments of the female thread 47.

(49) Preferably, the containers 2, 2a-2d are twisted by less than a half turn, in particular preferred by approximately a quarter turn, in order to engage a non-detachable and/or locked connection.

(50) The female connector 6, as well as the male connector 5, comprise a duct 12, 13, which enables the passage of liquid, when the containers 2, 2a-2d are fully connected (e.g. via the channel 23 of the membrane breaker insert 20, shown in FIG. 13-14a).

(51) FIG. 6 is a perspective view of the uppermost container 2c of the mixing system 1 shown in FIG. 1.

(52) The uppermost container 2c comprises a hanger 3.

(53) The hanger 3 is hinged and can be flapped out by pulling at the lug 14. If the hanger 3 is in a retracted position, the hanger 3 is, according to an embodiment of the invention, snapped in.

(54) In this embodiment, the hanger 3 is a fixed component of the container 2c.

(55) According to an embodiment of the invention (not shown), each of the containers 2a-2c of the mixing system 1 comprises such a hanger 3, so that each of the containers 2a-2c can be used as the uppermost container 2c.

(56) According to another embodiment of the invention (not shown), the hanger 3 is a separate element of the mixing system 2. The hanger 3 can be part of a separate component, which can be connected with a female connector 6 of the topmost container 2c of the mixing system 1.

(57) In particular, the hanger 3 can be connected also to a cartridge 4 (as e.g. shown in FIG. 2 and FIG. 3) or to a vial or ampoule holder 15 (as shown in FIG. 7 and FIG. 8).

(58) FIG. 7 is a perspective view of a mixing system 1, which comprises three containers 2a-2c connected to each other (corresponding to the mixing system 1 shown in FIG. 1).

(59) The mixing system 1, shown in FIG. 7, comprises a vial holder 15 (instead of a cartridge 4), which is connected to the female connector 6 of the uppermost container 2c.

(60) The vial holder 15 comprises a cover 16 with a grip. The cover 16 can be removed in order to insert an ampoule or a vial (not shown).

(61) FIG. 8 is a detail perspective view of the vial holder 15, wherein the cover 16 is removed.

(62) The vial holder 15 comprises a male connector 5 for connecting the vial holder 15 to a female connector 6 of a container 2, 2a-2d.

(63) The male connector 5 of the vial holder 15 corresponds to the male connector 5 of the containers 2, 2a-2d.

(64) After removing the cover 16, a vial or an ampoule (not shown) can be inserted into a receiving space 17 of the vial holder 15.

(65) The receiving space 17 is equipped with engagement hooks 19.

(66) The engagement hooks 19 are resiliently supported by bending arms, which axially extend through the vial holder 15 and are adjacent to the receiving space 17.

(67) After fully inserting the vial or ampoule into the receiving space 17, the vial or ampoule is locked in the receiving space by the engagement hooks 19. Preferably, the vial or ampoule is automatically opened in this locked condition, e.g. by opening the vial or ampoule with a piercing element (not shown). The piercing element can be part of the vial holder 15 and/or of the female connector 6 of the container 2, 2a-2d. If the piercing element is part of the vial holder 15, the vial holder 15 is preferably connected to the female connector 6 before inserting the vial or ampoule into the receiving space 17.

(68) With this vial holder 15 a preferably liquid ingredient, e.g. a preferably liquid pharmaceutical ingredient, can be added to the parenteral nutrition, which is mixed in the mixing system 1.

(69) FIG. 9 is a perspective cut-away view of two containers 2a, 2b, which are connected to each other.

(70) The male connector 5 comprises a membrane 9a which closes the male connector 5.

(71) FIG. 10 is a detailed view of area A of FIG. 9. The female connector 6 of the container 2a comprises the membrane 9b and the male connector 5 of the container 2b comprises the membrane 9c.

(72) When the containers 2a and 2b are completely connected, the membranes 9b and 9c are automatically opened by a membrane breaker insert 20. Thereby a channel 23 is formed between the containers 2a and 2b, which enables the passage of liquid. This is shown in detail with reference to the following drawings of FIG. 11 to FIG. 21.

(73) FIG. 11 is a perspective view of the container 2b.

(74) In this embodiment, the membrane breaker insert 20 is an integral part of the male connector 5.

(75) The membrane breaker insert 5 is inserted in the duct 13 of the male connector 5.

(76) According to other embodiments of the invention (not shown) the membrane breaker insert can also be an integral component of the female connector 6 or can be provided as a separate component of the mixing system 1.

(77) FIG. 12 is a perspective cut-away view of the container 2b showing now the inner part of the membrane 9c and the adjacent membrane breaker insert 20.

(78) The membrane breaker insert 20 is inserted in the duct 13 and stays on the membrane 9c of the male connector 5.

(79) FIG. 13 and FIG. 14 are perspective views of the membrane breaker insert 20.

(80) As shown in FIG. 13, the membrane breaker insert 20 comprises a discoidal collar 21, which is inserted in the duct 13 of the male connector 5.

(81) In order to enable the passage of liquid, the membrane breaker insert 20 comprises a central channel 23.

(82) On one side of the membrane breaker insert 20 a cone shaped segment 22 surrounds the channel 23. The cone shaped segment 22 forms an edge 27, which is preferably embodied as a sharp edge 27, e.g. a cutting edge 27, which opens the membrane 9b of the female connector 6.

(83) FIG. 14 shows the opposite side of the membrane breaker insert 20. On the opposite side of the cone shaped segment 22 the membrane breaker insert 20 comprises a ring 24 of breaker members 25, which are circularly distributed around the channel 23.

(84) FIG. 14a is a detailed view of the area B of FIG. 14. The breaker members 25 are essentially wedge-shaped, pointing with their small sides to the central channel 23.

(85) Therefore, the top side 26 of the breaker members 25 is flat, so that the breaker members 25 will not damage the membrane 9c during transportation of the container 2, 2a-2d.

(86) FIG. 15 is a further cut-away side view of the container 2b, comprising the membrane breaker insert 20 in the male connector 5.

(87) FIG. 16 is a detailed view of the area C of FIG. 15.

(88) The membrane breaker insert 20 is inserted into the duct 13 and stays on the membrane 9c of the male connector 5.

(89) The male connector 5 further comprises a seal 29, in this embodiment a lip seal, which extends around the inner sidewall 28 of the male connector 5, respectively of the duct 13.

(90) The seal 29 provides a fluid-tight connection of the male connector 5 and the connected female connector 6. The seal 29 is also used to hold the membrane breaker insert 20 in its position.

(91) FIG. 17 is a detailed view of the area D of FIG. 16.

(92) The sidewall 28 of the male connector 5 comprises an annular projection 30 onto which the membrane 9c is applied (e.g. by welding or gluing).

(93) To assemble the container 2b, the membrane 9c is applied onto the annular projection 30 of the duct 13. Then, the membrane breaker insert 20 is inserted into the duct 13 upon the membrane 9c. Hereupon, the seal 29 is inserted into the duct 13. The seal 29 holds the membrane breaker insert 20 in its position, so that the membrane breaker insert 20 is hold between the membrane 9c, which is supported by the annular projection 30, and the seal 29.

(94) As mentioned above, the seal 29 further enables a fluid-tight connection immediately when the male connector 5 is inserted into a female connector 5 of another container 2, 2a-2d.

(95) FIG. 18 is an exploded cut-away view of the containers 2a and 2b, which are going to be connected, thereby forming a channel, which enables the passage of liquid in order to mix the liquid ingredients of the containers 2a and 2b.

(96) The containers 2a and 2b are connected by screwing the containers 2a and 2b together. A channel is formed since the membrane breaker insert 20 opens the membrane 9c of the male connector 5 of container 2b as well as the membrane 9b of the female connector 6 of container 2a. Fluid can flow through the channel 23 of the membrane breaker insert 20.

(97) The connection of the containers 2a and 2b is preferably performed in two steps.

(98) For this purpose, the male and/or the female connector 5, 6 may comprise a locking device 40, e.g. a locking device 40 as shown in FIG. 23 and FIG. 24.

(99) The general concept of such a two-step-process could be as described as following:

(100) In a first step, the containers 2a and 2b are twisted against each other and thereby connected. When twisting the containers 2a, 2b, the locking device 40 snaps into a first position. In this first position, the containers 2a, 2b cannot be twisted in the reverse direction. The containers 2a, 2b are mechanically connected in this first state and preferably form a fluid-tight sterile connection due to the seal 29.

(101) However, membranes 9b and 9c are not yet opened. There is still no channel, which would enable the passage of liquids.

(102) By performing this first step, a preassembled mixing system 1 is provided.

(103) By further twisting the containers 2a and 2b against each other in second step, the locking device 40 snaps into a second position. In this second state the membranes 9b and 9c are opened and the liquid contents of the containers 2a, 2b can be mixed. Preferably this second twisting requires a higher torque.

(104) In the embodiment shown in FIG. 18 the male connector 5 of the container 2a comprises a septum 32, which is inserted into the duct 13 and which is pierceable by a spike or by a needle in order to deliver the mixed parenteral nutrition to the patient.

(105) The spike or the needle can be vented component. According to another embodiment of the invention, at least one container of the mixing system is or can be vented, so that also a non-vented spike or needle can be used.

(106) The male connector 5 further comprises, in this embodiment, a tamper-evident seal 33. The tamper-evident seal 33 e.g. can be embodied as a foil 33, which is applied onto the end face of the male connector 5.

(107) To connect the male connector 5 of the container 2a to another container or to expose the septum 32 of the container 2a, the foil 33 can be peeled off.

(108) The female connector 6 can also comprise a tamper-evident seal (not shown).

(109) With reference to FIG. 19-FIG. 21, it is shown in detail, how the membranes 9b and 9c are opened by the membrane breaker insert 20, when twisting the containers 2, 2a-2d against each other.

(110) FIG. 19 is a detailed perspective of a cut-away view of the area of the male connector 5 of container 2b and of the female connector 6 of container 2a. At the left view, the containers 2a and 2b are mechanically connected, but the containers 2a and 2b are not twisted as much as it is necessary to open the membrane 9c of the male connector 5. The two containers 2a and 2b are in a first connection state. The membrane 9c of the male connector 5 comprises, in this embodiment, a star-shaped precut 46.

(111) The right view of FIG. 19 illustrates the two containers 2a and 2b in their final second connection state. When further twisting the containers 2a, 2b against each other, the star-shaped precut 46 of the membrane in 9c is opened by the ring 25 of breaker members 24 (see FIG. 14). By screwing the containers 2a and 2b together, the ring 25 of breaker members 24 is pressed onto the adjacent surface of the membrane 9c, thereby slicing the star-shaped pre-cut 46, as a result the membrane 9c is opened.

(112) FIG. 20 is a further cut-away view of the containers 2a and 2b, showing now the membrane 9b of the female connector 6. The left view shows the two containers 2a and 2b in the first connection state. The right view shows the two containers 2a and 2b in the final second connection state.

(113) As shown in the left view, the membrane 9b of the female connector 6 comprises a pre-cut 31. The pre-cut 31 is exemplary shown as a U-shaped pre-cut 31.

(114) As shown in the right view, the U-shaped pre-cut 31 is opened by the cone shaped segment 22 of the membrane breaker insert 20.

(115) Now, a duct 13 is established or open, which enables the passage of liquid between the containers 2a and 2b trough the channel 23 of the membrane breaker insert 20.

(116) The size of the channel 23 is large enough to enable the mixing of the liquid content of connected containers 2, 2a-2d by agitating the containers 2, 2a-2d.

(117) FIG. 21 is a detailed cut-away view of the area of the membrane breaker insert 20 showing the male connector 5 of the container 2b and the female connector 6 of the container 2a in the final second connection state. The pre-cut 31 of the membrane 9d of the female connector 6 is opened by the cone shaped segment 22 of the membrane breaker insert 20. The pre-cut 46 of the membrane 9c is opened by the ring 25 of breaker members 24 of the membrane breaker insert 20.

(118) FIG. 22 is a sectional view of a further embodiment of a container 2d, which can be one component of the mixing system 1.

(119) The container 2d also comprises a male connector 5 and a female connector 6 at both opposite sides of its housing. The connectors 5 and 6 can be embodied as described above.

(120) In this embodiment, the container 2d is embodied, at least in parts, as a bellows 34.

(121) This embodiment of the container 2d can be used, for example, as an expandable component of the mixing system 1 in order to provide an additional mixing volume by expanding the container 2d.

(122) In addition, the container 2d can be used as a pump. In particular, the mixing system 1 can comprise two containers 2d, which are embodied as bellows 34. In this embodiment, the liquid content in the mixing volume, which consists of the entire volume of all connected containers 2, 2a-2d, can be mixed by using at least one of the containers 2d (embodied as a bellows) as a pump, thereby using the other container 2d (being embodied as a bellows) as a buffer volume. By expanding and/or compressing the bellows a pumping action can be generated.

(123) FIG. 23 and FIG. 24 are schematic drawings of a locking device 40 used to connect the containers 2a and 2b in two steps. FIG. 23 shows a front view on the male connector 5 of container 2b.

(124) FIG. 24 is a front view on the female connector 6 of container 2a.

(125) The locking device 40 consists of an outer member 36 and an inner member 35.

(126) The inner member 35 is preferably part of a male connector 5 (see FIG. 23). The inner member 35 has a ring-shaped structure, wherein the thickness of the ring increases in thread direction. The inner member 35 has at least one, preferably two steps 37 from the smallest to the largest diameter of the structure. The steps 37 are essentially aligned in a radial direction. The inner member 35 can be placed, for example, above the thread 7 of a male connector 5 (not shown).

(127) As shown in FIG. 24, the female connector 6 comprises an outer member 36, which can be placed, for example, below or in the area of the notches 11 of the female connector 6. In the shown embodiment two outer members 36 are provided.

(128) Preferably each of the outer members 36 comprises at least one resilient end section 38 comprising the edge 39 of the outer member 36.

(129) When engaging the inner member 35 and the outer member 36 by twisting the containers 2a and 2b against each other, the steps 37 of the inner member 35 force the resilient end sections 38 of the outer member 36 to spread outwardly.

(130) Then, the steps 37 of the inner member 35 pass the edges 39 of the outer member 36. The resilient end sections 38 then snap in, so that the containers 2a and 2b cannot be twisted in the reverse direction anymore.

(131) There is now established a non-detachable connection between the containers 2a and 2b in order to provide a pre-assembled mixing system 1. The two containers 2a and 2b are in a first connection state.

(132) Preferably, the resilient end sections 38 generate an acoustically perceptible “click” when snapping in. With this sound it is signaled to the user, that the containers 2a and 2b are non-detachably connected.

(133) In a second step, in order to generate a channel which enables the passage of liquid, the user continues twisting the containers 2a and 2b, preferably with more torque. In particular, a resistance has to be overcome when twisting the containers 2a, 2b to a final connected position.

(134) Now, the resilient sections 45, which follow the resilient end section 38, are forced outwardly. In a final position, the edge 41 snaps in behind the step 37.

(135) Preferably, thereby a second “click” is generated, signaling that now a connection, which enables the passage of liquid has been established, so the user can mix the ingredients, e. g. by agitating.

(136) Now, the containers 2a and 2b are non-twistably connected. The final second connection state of the two containers 2a and 2b is reached. The markings 44 of the containers 2a and 2b are in the position shown in FIG. 1.

(137) FIG. 25 is a schematic view of a preassembled mixing system 1, which comprises a secondary package 42.

(138) The mixing system 1 as shown in FIG. 1 is preassembled, e.g. by engaging a non-detachable connection of the containers 2, 2a-2d of the mixing system 1. The containers 2, 2a-2d are in their first connection state.

(139) Then, the containers 2, 2a-2d are inserted into a secondary package 42, which has preferably an oxygen-diffusion barrier, in particular which has an oxygen-tight coating, e.g. a metal coating.

(140) In this embodiment, the secondary package 42 is embodied as a tube, for instance as a cylindrical-shaped package, which comprises a lid 43, which can be lifted off by the user.

(141) Preferably, the leaflet (not shown) of the preassembled mixing system 1 is inserted into the secondary package 42. Therefore, the preassembled mixing system 1 can be easily equipped with various country-specific leaflets.

(142) FIG. 26 shows an embodiment of mixing systems 1, wherein the septum 32 for inserting a spike or a needle is embodied as a separate modular component 48.

(143) The septum module 48 comprises a female connector 6, which can be connected to a male connector 5 of a container 2. Further, a septum 32, which is pierceable by a spike or a needle, is placed in the duct 12 of module 48.

(144) The septum module 48 can be connected to a lowermost container (e.g. container 2a in FIG. 1) of a mixing system 1.

(145) Preferably, the female connector 6 of the septum module 48 also comprises a membrane breaker insert 20 as described with reference to FIG. 9-FIG. 22 (not shown). Accordingly, when connecting the septum module 48 to a container, 2, 2a-2d, the male connector 5 of the container 2, 2a-2d is automatically opened by slicing a membrane 9c of the male connector 5.

(146) FIG. 26a is a perspective view of a container, which is equipped with a modular septum 48 of different design. This modular septum 48 is adapted to be screwed into the male connector 5 of the lowermost container 2 (e.g. container 2a in FIG. 1) of a mixing system 1

(147) FIG. 27 is a flow chart of a method of mixing parenteral nutrition according to an embodiment of the invention.

(148) A first container 2, 2a-2d comprising a first liquid for parenteral nutrition is connected to a second container 2, 2a-2d comprising a second liquid for parenteral nutrition.

(149) In a first step, an undetachable mechanical connection is formed. This is signaled to the user by a first click. This is the first connection state of the containers 2, 2a-2d.

(150) In a second step, a channel, which enables the passage of liquid, is formed and the containers 2, 2a-2d are undetachably locked. This represents the final second connection state of the containers 2, 2a-2d. The connected containers 2, 2a-2d provide a mixing volume for mixing the liquids of the containers 2, 2a-2d by agitating.

(151) Then, a spike or a needle is inserted into a septum 32 to deliver the mixed parenteral nutrition to the patient, for instance via a feeding set.

(152) The invention provides a very flexible system to mix individual compositions of parenteral nutrition.

(153) Individual components with different amounts of ingredients can be prepared by the user or a preassembled mixing system can be provided.

(154) Each component has its own lifetime, but the lifetime of all components is not dependent on the lifetime of the most perishable good. Components, which are easy to produce, e.g. glucose solutions, can be produced near to the end user and components, which are difficult to manufacture (e.g. fat emulsions) can be produced in a specialized production sites. Only those products have to be delivered over longer distances.

LIST OF REFERENCES

(155) 1 mixing system 2, 2a-2d container 3 hanger 4 cartridge 5 male connector 6 female connector 7 thread 8 grip 9 9a-9c membrane 10 collar 11 notch 12 duct 13 duct 14 lug 15 vial holder 16 cover (with grip) 17 receiving space 18 bending arm 19 engagement hook 20 membrane breaker insert 21 collar 22 cone shaped segment 23 channel 24 ring of breaker members 25 breaker member 26 top side 27 edge (of cone shaped segment) 28 sidewall 29 seal 30 annular projection 31 pre-cut 32 septum 33 foil (of closure) 34 bellows 35 inner member 36 outer member 37 step 38 resilient end section 39 edge 40 locking device 41 edge 42 secondary package 43 lid 44 marking 45 resilient section 46 pre-cut 47 female thread 48 septum module.