Y-site drug compatibility with parenteral nutrition
Abstract:
Background: To describe physical intravenous y-site compatibility of 15 different medications with highly concentrated neonatal and pediatric parenteral nutrition (PN) compounds using existing and novel methods.
Methods: PN formulations were developed based on common prescribing practices in a 400+ bed free-standing children’s hospital. Medications at commonly-used pediatric concentrations were mixed in a 1:1 ratio with both pediatric and neonatal parenteral nutrition formulations and incubated at room temperature for 4 hours to simulate y-site administration. Samples were then analyzed using the United State Pharmacopeia (USP) chapter <788> recommended analytical technique of light obscuration (LO) in addition to novel flow imaging microscopy (FI) and backgrounded membrane imaging (BMI). Physical compatibility was determined using USP<788> particle count limits for all techniques.
Results: Most combinations were found to be compatible per USP<788> thresholds. Pediatric PN was incompatible by at least 2 methods with cisatracurium 2 mg/mL, sildenafil 0.8 mg/mL, furosemide 10 mg/mL, and ketamine 10 mg/mL. Neonatal PN was incompatible by at least 2 methods with cisatracurium 2 mg/mL and furosemide 10 mg/mL. Overall, results for 20 of the 30 combinations (66%) agreed across all 3 methods. FI and BMI results agreed for 22 of 30 combinations. LO agreed with FI in 25/30 combinations, and BMI and LO results agreed in 23/30 combinations.
Conclusion: Most combinations tested were found to be compatible across all methods. Novel methods of FI and BMI appear to be useful to furtherevaluate LO findings and improve accuracy of particle counts when assessing PN-medication combinations.
Reference:
Ross EL, Petty K, Salinas A, Her C, Carpenter JF. Simulated Y-site compatibility of Medications with concentrated Neonatal and Pediatric Parenteral Nutrition: A drug compatibility study. JPEN J Parenter Enteral Nutr. 2022 Dec 29. doi: 10.1002/jpen.2469. Epub ahead of print. PMID: 36582024.