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4CPS-211 Reduction of flushing volume and incompatibilities by a clinical pharmacist in a paediatric intensive care unit
  1. M Kleinlein1,
  2. S Marschler1,
  3. M Hoeckel1,
  4. MP Neininger2,
  5. T Bertsche2
  1. 1Pharmacy, Gesundheit Nordhessen Holding AG, Kassel, Germany
  2. 2Clinical Pharmacy, Institute of Pharmacy, Medical Faculty, Leipzig University and Drug Safety Center, Leipzig University and University Hospital, Leipzig, Germany


Background and importance Incompatibilities of drugs administered via the same Y-site can have serious consequences. Therefore, incompatible drugs should be administered through different infusion lines. If separate administration is not possible, flushing should be performed between drug administrations. However, children in critical care units have a high risk for fluid overload which is associated with a higher morbidity. Consequently, unnecessary fluids should be avoided [1].

Aim and objectives The aim of our study was to evaluate the intervention to reduce flushing volume without increasing incompatibilities in a paediatric intensive care unit (PICU).

Material and methods We performed an intervention study in our 13-bed PICU in Kassel to determine the flushing volume (S1P0 January–July 2020; S1P1: October 2020–August 2021). Patients with ≥2 IV drugs, stay >24 hours, and age 0–18 years were included. As part of this study two 4-week bedside observations were conducted to survey compatibility of coadministered drugs (S2P0 July 2020; S2P1 October 2020). As an intervention, patient-specific compatibility and flushing charts were created by a clinical pharmacist. The Mann–Whitney U test was used for quantitative variables and the χ2 test for categorial variables. The analyses were performed using R version 4.1.1.

Results 170 patients (85 patients per period) were included in the intervention study. 23 (S2P0) and 24 (S2P1) patients with 504 (S2P0) and 523 (S2P1) drug combinations were part of the bedside observation. The median of the flushing volume was significantly reduced from 0.68 mL/kg/day (Q25/Q75 0.31/1.33) to 0.35 mL/kg/day (Q25/Q75 0.08/0.74); p<0.001). Also, the number of daily flushing processes decreased (S1P0 median (Q25/Q75) 2.60 (1.33/3.40), S1P1 median (Q25/Q75) 1.44 (0.67/2.33); p<0.001). Furthermore, the observational study demonstrated a 51% reduction in the number of administered incompatible combinations (S2P0: 8.93%, S2P1: 4.39%, χ²= 7.46; p=0.002). Combinations without literature data were administered in both periods, and again the number could be reduced (S2P0: 8.13%, S2P1: 3.82%, χ²=8.96, p=0.003).

Conclusion and relevance Our results show that incompatibilities are very common in PICU and that relevant compatibility data, especially for children, are still lacking. A pharmaceutical intervention can not only help to reduce flushing volume but can also reduce incompatibilities.

References and/or acknowledgements 1. Alobaidi. JAMA Pediatr 2018;172(3):257–268.

We would like to thank BBraun Melsungen AG, who supported the study with an unrestricted grant.

Conflict of interest No conflict of interest

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