Background Drug incompatibility is a problem when managing patients in intensive care units. Patients receive many drugs simultaneously but through limited venous accesses. The recent marketing of new multi-lumen infusion access device may open the way to preventing incompatibility.
Purpose To evaluate the impact of multi-lumen infusion access devices connected to single-lumen central venous catheters on the occurrence of known drug incompatibilities through a controlled in vitro study.
Materials and Methods Two infusion devices were studied: 1) a standard set with six-gang-manifolds and its extension line and 2) a multi-lumen infusion access device with nine lumens (Edelvaiss-Multiline, Doran International, France). Six drugs were selected: three basic drugs (furosemide, pantoprazole and amoxicillin/clavulanic acid) and three acid drugs (amiodarone, dobutamine and midazolam). Two, four or six drugs and an infusion vehicle (saline, Ringer’s or 5% glucose) were infused simultaneously. The infusion rate of the vehicle was initially set at 100 mL/h and decreased stepwise by 10 mL/h until precipitate formation occurred. Physical incompatibility was assessed by visual inspection and sub-visible particle count test as defined by the European Pharmacopeia according to the European Pharmacopeia. The lowest value of the vehicle infusion rate that satisfied the two tests was reported for each infusion set and for each drug combination.
Results The use of multiline access devices contributed to preventing drug incompatibilities when simultaneously infusing two and four drugs. Indeed, infusion vehicle flow rate gains oscillated between 10 and 40 mL per hour, in more than 55% and 25% of cases, respectively for two and four drugs. When infusing six drugs simultaneously, no differences were identified.
Conclusions Our main hypothesis is that fluid dynamics differ depending on the infusion device resulting in differences in the contact time between drugs. Under specified infusion conditions, the nine-lumen device prevents physical drug incompatibilities.
No conflict of interest.
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