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How safe is Y-site intravenous drug administration? – CE activity

"Potential complications of co-administration of incompatible drugs include precipitation in the infusion line or central venous catheter leading to its occlusion" Stawny et al (2020).
Abstract:

A serious problem in everyday clinical practice is the co-administration of drugs using the same infusion line. Potential complications of co-administration of incompatible drugs include precipitation in the infusion line or central venous catheter leading to its occlusion. Administration of precipitate and large lipid droplets into the venous system may lead to the embolization of capillaries and local or systemic inflammatory reactions, with the consequences of venous thrombosis, chronic venous insufficiency, and even pulmonary embolism. The co-administration of drugs must always be confirmed and clearly defined. The study aimed to determine the interaction between colistin (COL) in the dose used during intermittent hemodialysis and five different ready-to-use PN admixtures (PN) (Kabiven, Smofkabiven, Olimel N9E, Nutriflex Lipid Special, and Nutriflex Omega Special). COL-PN compatibilities were tested by comparing physicochemical properties (pH, zeta potential, lipid emulsion particle size) of COL and PN at three time points: immediately after sample preparation, after ten minutes, and after four hours. No changes in the visual inspection were observed. Both PN without COL and COL-PN samples remained white, homogeneous oil-in-water emulsions with no signs of phase separation, precipitation, or color change. There were no significant changes in pH, and the mean droplet diameter remained below the acceptance limit of 500 nm. The zeta potential and osmolality of COL-PN samples ranged from -21.4 to -7.22 mV and from 567 to 1304 mOsm/kg, respectively. The COL does not influence the physical stability of studied PN admixtures. The co-infusion of COL with Kabiven, Nutriflex Lipid Special, Olimel N9E, Nutriflex Omega Special, and Smofkabiven is possible in the dose used during intermittent hemodialysis.

Reference:

Stawny, M., Gostyńska, A., Nadolna, M. and Jelińska, A. (2020) Safe Practice of Y-Site Drug Administration: The Case of Colistin and Parenteral Nutrition. Pharmaceutics. 12(3), p.E292. doi: 10.3390/pharmaceutics12030292.

Continuing Education Activity

Welcome to the IVTEAM continuing education multiple-choice quiz on How safe is Y-site intravenous drug administration - CE activity. Once completed, you will be emailed the results of the quiz. We recommend you retain the email as proof of your continuing professional development. This is another free service provided by IVTEAM.

1. What is the rate rate of central catheter occlusion stated by the authors?
2. The authors suggest simultaneous administration of colistin (at doses used in critically ill patients who have intermittent hemodialysis) with PN admixtures is possible and safe. Yes or no?
3. As described by the authors, what he most common signs of incompatibility of drug–parenteral nutrition admixtures? Multiple questions may be correct.
4. What is the main outcome of precipitation for the standard of the infusion?

Thank you for completing the How safe is Y-site intravenous drug administration - CE activity multiple-choice quiz on the October 20, 2020.



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