J Korean Pediatr Soc.  1998 Jul;41(7):893-900.

Compatibility of Neonatal Parenteral Nutrient Solutions with Commonly Used Drugs during Y-site Delivery in NICU

• Choi JH
• Jeong KJ
• Cho HR
• Yim DS
• Choi SK
• Lee KH

Abstract

PURPOSE: Because vascular access sites in neonates are limited, intravenous (IV) medications must often be mixed with maintenance fluids, including parenteral nutrient (PN) solutions. This study was done to determine whether IV medications commonly prescribed in the neonatal in- tensive care unit (NICU) are compatible with the two neonatal PN solutions.
METHODS
The compatibility of neonatal PN solutions and selected other drugs during Y-site delivery was evaluated. Secondary drugs were administered at selected concentrations, rates and delivery by method commonly used at the NICU. Drugs administered by syringe pump over 30min : amikacin, cefotaxime, ceftriaxone, piperacillin, phenytoin, aminophylline, ceftazidime, fluconazole, indomethacin. Drugs administered by IV push : ampicillin+sulbactam, penicillin G potassium, NaHCO3, ranitidine, epinephrine, furosemide, dexamethasone. Drugs administered by IV infusion for at least 60min : acyclovir, amphotericin B, vancomycin, dobutamine, dopamine, doxapram. After each test, the Y injection site and tube below the Y injection site were visually inspected for precipitation and color change. If no particles or color change was detected, the solution was tested and analyzed by a liquid borne particle analyzer (LBPA).
RESULTS
White precipitate formed immediately after Y-site administration : phenytoin, aminophylline (undiluted solution), ampicillin+sulbactam (undiluted solution). Number of particles observed with LBPA exceeded the KP guideline limit immediately after Y-site administration and white precipitate formed after 3-4 hour : ceftriaxone, NaHCO3 (1 : 2 diluted solution).
CONCLUSION
These results revealed that several lV drugs prescribed in NICU formed precipitate and had a color change, when mixed with neonatal TPN solutions.

Keyword

Total parenteral nutrition; Neonatal intensive care unit; Compatibility test

MeSH Terms

Acyclovir
Amikacin
Aminophylline
Amphotericin B
Cefotaxime
Ceftazidime
Ceftriaxone
Dexamethasone
Dobutamine
Dopamine
Doxapram
Epinephrine
Fluconazole
Furosemide
Humans
Indomethacin
Infant, Newborn
Parenteral Nutrition, Total
Penicillin G
Phenytoin
Piperacillin
Ranitidine
Syringes
Vancomycin
Acyclovir
Amikacin
Aminophylline
Amphotericin B
Cefotaxime
Ceftazidime
Ceftriaxone
Dexamethasone
Dobutamine
Dopamine
Doxapram
Epinephrine
Fluconazole
Furosemide
Indomethacin
Penicillin G
Phenytoin
Piperacillin
Ranitidine
Vancomycin