In vitro compatibility of various cardioactive drugs during simulated Y-site administration
- Valia Humbert-Delaloye1,2,
- Markoulina Berger-Gryllaki1,
- Pierre Voirol1,
- Laurent Gattlen3,
- André Pannatier1,2
- 1Department of Pharmacy, University Hospital Centre (CHUV), Lausanne, Vaud, Switzerland
- 2Hospital & clinical pharmacy, School of Pharmaceutical Sciences, University of Geneva and University of Lausanne, Geneva, Switzerland
- 3Adult Intensive Care Unit, University Hospital Centre (CHUV), Lausanne, Vaud, Switzerland
- Correspondence to Valia Humbert-Delaloye, Department of Pharmacy, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 46, Lausanne, Vaud 1011, Switzerland;
- Received 10 October 2012
- Revised 23 November 2012
- Accepted 30 November 2012
- Published Online First 10 January 2013
Objectives Physicochemical incompatibilities between intravenous drugs are a recurrent problem in ICUs. A study was undertaken to evaluate the physicochemical compatibility of five common associations of cardioactive drugs: dopamine (DA)–norepinephrine (NE); dobutamine (DU)–NE; amiodarone (AM)–DU–NE; DU–sodium nitroprusside (NI)±sodium thiosulfate (THIO); and NI–THIO.
Methods The drugs were diluted in the usual manner performed in the ICU. Their compatibility was verified by visual inspection of the different mixtures in glass tubes and by chemical assays and pH determination of the mixtures collected during in vitro simulated Y-site administration (solutions prepared in syringes placed on syringe pumps and connected to a Swan–Ganz catheter). Solutions were considered to be compatible in the absence of any visual change in the solution and of any significant variation in pH value and drug concentration at each time of the study.
Results DA–NE, DU–NE, DU–NI (±THIO) and NI–THIO associations were compatible over 24 h in the tested proportion ranges, with the proviso that NI was protected from light. In addition, it was observed that AM, DU and NE were compatible but, in the dynamic simulation, AM reached the expected concentration only after 4 h.
Conclusions When combined, the cardioactive amines were stable over 24 h. AM was compatible with DU and NE, but with a latency period owing to its adsorption on the heparin-coated Swan–Ganz catheter. Mixtures involving NI were compatible provided that NI was supplied in amber syringes or protected with aluminum foil.