Background : The hospitalized patients requiring parenteral nutrition (PN) often need to receive intravenous medications as well, as noted in some cases. The Y-site administration is occasionally necessary, but some physicochemical incompatibilities can occur between the medications and PN. The absence of drug compatibility information with 3-in-1 parenteral nutrition admixture (PNA) has been problematic in this case. The infusion of a precipitate or destabilized emulsion can be harmful for the patients. Therefore, the aim of this study was to evaluate the physical compatibility of 2 selected drugs during a simulated Y-site injection and additive condition into a 3-in-1 PNA.
Methods : 3-in-1 PNA (OMAFONE® Inj 986 mL) were tested with two drugs (diltiazem, vasopressin). PNAs and drugs were mixed in 1:1(v/v) proportions and the compatibility was assessed at the time of mixing and after 1, 24, 48 and 72 hours. Chiefly, the assessment of potential precipitation and the emulsion stability was performed by a subvisual particle counting an, through visual examinations and a measurement of globule size distribution.
Results : In all samples we did not observe changes on the visual examinations. It is noted that the oil droplet mean size changes over 1.5 μm are to exceed 2% in the Y-site samples of diltiazem and vasopressin within 24 hours. In particular, these samples of vasopressin did not disappear until after a 72 hours timeframe. However, the globule size distribution via a dynamic light scattering are maintained at 200-300 nm during the experimental period.
Conclusions : The present study experiment noted the compatibility of 1 commercially available PNA and 2 medications. The extrapolation of compatibility data based on conditions applicable for other products is not recommended. It is noted that a different outcome can also be a result of differences in the methodology or interpretation of the results. Finally, we recommend that a filter is concerned primarily with the protection of patients from the effects of an infusion of particulates and chemical precipitates. The appropriate use of this complex therapy is able to maximize the clinical benefit while minimizing the potential risks for adverse events.
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