The Physical Compatibility of Intravenous Injectable Drugs Frequently Administered in Pediatric Intensive Care Units at Queen Sirikit National Institute of Child Health (QSNICH)
Keywords:
Physical compatibility, Y-site connector compatibility, Pediatric critical careAbstract
Background: Critically ill pediatric patients often require multiple intravenous (IV) drugs to be administered at the same time. However, because IV access sites are limited, it’s necessary to administer as many as two to four drugs through the same IV line via a y-site connector. Pharmacists must first check charts for IV drugs y-site connector compatibility but information for some medications isn’t available. Objective: The objective of this study was to determine the physical compatibility of 24 pairs of medications. The study’s results on considering multiple drug compatibility will benefit the treatment of patients, while dissemination of the information will also be useful to other agencies. Methods: A 1:1 ratio of 24 pairs of drugs at maximum concentration were mixed in disposable syringes. The physical compatibility, or the drugs’ precipitation, was observed by the naked eye and under a light microscope with a 40x magnification high-power lens at 0-hour (immediately) and 1-hour, 2-hours or 4-hour intervals, depending on individual drug injections administered at room temperature (25°C) after mixing. Particles with ≥ 7
m were observed via the light microscope, while acidity and basicity of the mixtures were measured with a pH meter. Results: Of 24 pairs of drugs, physical compatibility was found in 20 pairs of drugs (83.3%) at 0-hour, and 1-hour, 2-hours or 4-hours. For example, fosfomycin (D5W) 20 mg/ml + fluconazole (undiluted) 2 mg/ml, and NaHCO3 (D5N/2) 12.5 mg/ml + K2HPO4 (D5N/2) 10 mg/ml. Four pairs of drugs (16.7%) were found to be incompatible. For example, meropenem (D5W) 50 mg/ml + levofloxacin 5 mg/ml, and meropenem (D5W) 50 mg/ml + MgSO4 (D5N/2) 60 mg/ml. Conclusions: This study identified y-site connector physical compatibility information for 24 pairs of injectable drugs that were used in Pediatric Intensive Care Units (PICU).
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