Abstract
Background: In neonatal intensive care units (NICUs), the simultaneous administration of drugs requires complex infusion methods. Such practices can increase the risk of drug incompatibilities resulting in the formation of a particulate load with possible clinical consequences. Methods: This paper evaluates strategies to reduce the particulate load of a protocol commonly used in NICUs with a potential medical incompatibility (vancomycin/cefepime combination). The protocol was reproduced in the laboratory and the infusion line directly connected to a dynamic particle counter to evaluate the particulate matter administered during infusion. A spectrophotometry UV assay of cefepime evaluated the impact of filters on the concentration of cefepime administered. Results: A significant difference was observed between the two infusion line configurations used in the NICU, with higher particulate load for cefepime infused via the emergency route. There was no change in particulate load in the absence of vancomycin. A filter on the emergency route significantly reduced this load without decreasing the cefepime concentration infused. Preparation of cefepime seemed to be a critical issue in the protocol as the solution initially contained a high level of particles. Conclusion: This study demonstrated the impact of a reconstitution method, drug dilution and choice of infusion line configuration on particulate load.
Highlights
The summary of product characteristics (SmPC) was respected. It states that cefepime is compatible with the following solvents and solutions: WFI, saline solution (SS)
To determine if particulate load was due to an incompatibility between vancomycin and cefepime, a modification was made to the CEF infusion line
Vancomycin was replaced by its diluent (G5%) (CEF infusion line without vancomycin) (Figure 4A)
Summary
Infusion devices are becoming more and more complex to ensure the simultaneous administration of drugs that are sometimes incompatible with each other and can have a clinical impact [1,2] with complications such as phlebitis, pulmonary or renal embolisms [3,4,5] and inflammations [6,7]. In neonatal intensive care units (NICUs), the simultaneous administration of drugs requires complex infusion methods Such practices can increase the risk of drug incompatibilities resulting in the formation of a particulate load with possible clinical consequences.
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