Investigations of Physical Compatibilities of Commonly Used Intravenous Medications with and without Parenteral Nutrition in Pediatric Cardiovascular Intensive Care Unit Patients.

Greg Gorman,Katherine Greenhill,Erin Hornsby

doi:10.3390/ph12020067

Greg Gorman, Katherine Greenhill + Show 1 more

Open Access

https://doi.org/10.3390/ph12020067

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Journal: Pharmaceuticals (Basel, Switzerland)	Publication Date: May 4, 2019
Citations: 9	License type: CC BY 4.0

Affiliation: Samford University

Abstract

Many pediatric intensive care patients require numerous specialized intravenous (IV) medications at various dosages in multiple fluids often with nutritional support. This requires several venous access points due to lack of Y-site compatibility data for combinations of two or more drugs. This project investigated physical compatibilities of intravenous medications: alprostadil, calcium gluconate, dexmedetomidine, epinephrine, norepinephrine, esmolol, furosemide, vasopressin, and milrinone with and without lipid-free total parenteral nutrition (TPN) commonly used in a pediatric cardiovascular intensive care unit (CVICU) patient. Actual drug combinations were evaluated using a simulated Y-site study design. Compatibility was determined based on observational data: odor (change/appearance), evolution of gas, and visual appearance combined with physical or chemical endpoints with predefined acceptance criteria: change in pH (± 1 unit), and turbidity (>0.5 NTU) at eight time points between 0 and 240 min. All binary drug combinations along with the four drug plus TPN combination were found to be physically compatible up to 240 min. The three drug combinations were determined to be incompatible and were not evaluated with TPN. This study demonstrates the utility of simulated Y-site study design to multi-drug combinations and increases the scientific body of knowledge related to medications used in a pediatric CVICU.

Highlights

Pediatric patients placed in an intensive care unit (ICU) require multiple intravenous medications and/or parenteral nutrition
Studies have shown that when compatibility data is missing, medications are likely to be mixed together inappropriately [2]. This can lead to events such as pulmonary embolism in the case of total parenteral nutrition (TPN) containing calcium and phosphorus when mixed with medications that can induce precipitate formation [1]
The objective of this study was to investigate the physical compatibilities of intravenous medications in circumstances where data for institutional specific pediatric concentrations and/or vehicles does not exist, or for multiple medications in the presence of a common TPN formulation in pediatric cardiovascular intensive care unit (CVICU) patients

Summary

Introduction

Pediatric patients (neonates through 18 years of age) placed in an intensive care unit (ICU) require multiple intravenous medications and/or parenteral nutrition. These medications may be administered together through a Y-site connection; depending on physical compatibilities, patients may require multiple access points, which can be difficult to establish [1,2]. Patients requiring continuous total parenteral nutrition (TPN) have greater complexity in their regimen due to the multiple components within TPN formulations which could potentially interact with medications This may lead to clinically suboptimal outcomes, or in the case of parenteral nutrition, malnutrition [1]. This can lead to events such as pulmonary embolism in the case of TPNs containing calcium and phosphorus when mixed with medications that can induce precipitate formation [1]

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