Background In intensive care units (ICUs), intravenous (I.V) accesses are usually limited, leading to concomitant administration of different drugs in the same infusion line.
Purpose The objectives were: to perform an observation of the administration of anti-infective drugs (antibiotics, antiviral and antifungal drugs) in the ICUs; to compare with compatibility data available in the literature; and in the absence of compatibility data, to test the physical compatibility in our laboratory.
Material and methods Between April and June 2018, an observational prospective study was realised over 2 weeks in each of the three ICUs selected. Patients receiving more than one I.V drug including an anti-infective drug in the same line simultaneously (Y-site injection or mixed in the same container) were included. All I.V. drugs were recorded as concentration, solvent, type of container and flow rate. Compatibilities were assessed pairwise by using three databases: The Handbook on Injectable Drugs 19th edition, King Guide to Parenteral Admixtures and Stabilis.
For missing data, three tests were realised for some pairwise: (drug A/drug B): 1 mL/9 mL; 9 mL/1 mL; and 5 mL/5 mL. Drugs were considered compatible if no precipitate, colour change or gas formation were observed after preparation and after a 1 hour and 4 hour storage at room temperature. For subvisual evaluation, turbidimetry by UV spectrophotometry was performed at 350, 410 and 550 nm as recommended by the European Consensus Conference.
Results A total of 123 associations between an anti-infective drug and another medication were observed. According to the literature, 33.3% (n=41/123) associations were compatible, 9.8% (n=12/123) were incompatible, 6.5% (n=8/123) had divergent data according to the databases and 50.4% (n=62/123) had no data available. Thirty-eight pairwise mixtures were studied. After laboratory tests, 71.0% (n=27/38) were evaluated as physically compatible, 7.9% (n=3/38) were found to be incompatible after visual evaluation and 21.1% (n=8/38) after only subvisual evaluation.
Conclusion This study demonstrated that some incompatible drugs were mixed before administration to the patient. After laboratory tests, new incompatibilities were found which gives additional information to the literature. However, many other mixtures should be still studied due to missing data.
References and/or acknowledgements No conflict of interest.
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