P.83 The compatibility of selected drugs on Y-siteddelivery of total parenteral nutrition (TPN) admixtures

Abstract

delivery of total parenteral nutrition (TPN) admixtures A. R. Minton, M. t. Bamett and A. G. Cosslett Welsh School of Pharmacy, University of Wales Cardiff, Cardiff, UK. Introduction: There is considerable information available on the compatibility between drugs during simulated Y-site infusion when an intravenous fluid and an additive are mixed in a 1:1 ratio by volume. 1'2'3 However the compatibility of selected drugs as additions to lipid emulsion and TPN Y-sited admixtures has not been extensively investigated. Aim of study: To evaluate the physical compatibility of selected drugs and lipid emulsions at Y-sites, and to determine whether the inclusion of such additives is possible without compromising patient safety. Method/Results: An Neubauer microscope slide was used to examine and record the interaction of the lipid phase containing Intralipid ® 20% with fat soluble vitamins, and an aqueous phase containing amino acids, glucose, macro and micro-nutrients. A Thoma T M microscope slide was used to determine changes in lipid emulsion globule size and a Malvem Mastersizer ® laser diffraction unit to measure changes in the lipid emulsion size distribution. The results show visually and microscopically that only 3 of the 14 drugs were physically incompatible during Y-site delivery. Largest particle Drug size observed Visual observations Erythromycin lactobionate 10 mm Increase in lipid emulsion globule size Phenytoin Precipitation Flucloxacillin Precipitation