Clinical implications of intravenous drug incompatibilities in critically ill patients

Benlabed, Malik; Perez, M.; Gaudy, Romain; Genay, Stéphanie; Lannoy, Damien; Barthélémy, Christine; Odou, Pascal; Lebuffe, Gilles; Décaudin, Bertrand

doi:10.1016/j.accpm.2018.04.003

Cited by 47 publications

(51 citation statements)

References 33 publications

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“…In a destabilised emulsion, an increase in droplet size will occur [14, 19,20]. Since intravenous infusion of enlarged droplets encompass potentially serious risks, droplet stability is essential for injectable emulsions [2][3][4][5][6][7][8][9]. Knowledge on propofol emulsion stability when coadministered with remifentanil is sparse.…”

Section: Discussionmentioning

confidence: 99%

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Emulsion Stability of Different Intravenous Propofol Formulations in Simulated Co-Administration with Remifentanil Hydrochloride

Nilsson

Nezvalová-Henriksen²,

Tho

2019

Pharmaceutical Technology in Hospital Pharmacy

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Abstract Background Propofol and remifentanil often need to be co-administered via the same intravenous catheter line, which predisposes to potential compatibility issues. Our aim was to determine and compare the emulsion stability of three propofol formulations, two with medium chain triglycerides and one with long chain triglycerides, when administered together with remifentanil hydrochloride. Methods Remifentanil hydrochloride (Ultiva ® ) 50 µg/mL was mixed with two concentrations (10 and 20 mg/mL) of each propofol formulation in mixing ratios 10+1, 20+1, 1+1 and 1+20. Emulsion stability was assessed immediately after mixing and 4 hours later by measurements of pH, mean droplet diameter, polydispersity index, and calculating percentage of fat residing in globules>5 µm (PFAT5). Results High PFAT5 values were observed in certain mixing ratios. The correlation between elevated PFAT5 and high propofol concentration (20 mg/mL), when remifentanil was in abundance and for long contact time indicated that these factors influenced the stability of the propofol emulsions. Conclusions Stability differences between the propofol formulations were identified under extreme test conditions. Co-administration of remifentanil and propofol in the same i.v. line is safe when propofol is in abundance. Caution is advised when remifentanil is present in equal parts or in abundance when co-administered with propofol 20 mg/mL.

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Section: Discussionmentioning

confidence: 99%

“…Entrapment in the liver, the reticuloendothelial system and several other organs has also been reported [6,7]. In addition, incompatibilities have been suspected of having a deleterious immunomodulating effect [8,9].…”

Section: Introductionmentioning

confidence: 97%

Emulsion Stability of Different Intravenous Propofol Formulations in Simulated Co-Administration with Remifentanil Hydrochloride

Nilsson

Nezvalová-Henriksen²,

Tho

2019

Pharmaceutical Technology in Hospital Pharmacy

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“…[26] Accordingly, electrolytes should be only added with caution to TPN admixtures, and the stability of the final product should be examined' before use. [27] On the other hand, several pathways are involved in chemical drug incompatibility, including oxidation, reduction and hydrolysis. These processes can be accelerated after reconstitution of dry powders, exposure to oxygen, ultraviolet light and changes in pH or temperature.…”

Section: Drug Incompatibilities: a Dilemma In Clinical Practicementioning

confidence: 99%

Nanomedicine: a new paradigm to overcome drug incompatibilities

Abdelkader

Fathi

Hamad

et al. 2020

Journal of Pharmacy and Pharmacology

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Objectives Drug incompatibilities may compromise the safety and effectiveness of combined drugs and result in mild‐to‐serious clinical complications, such as catheter obstruction, loss of drug efficacy, formation of toxic derivatives and embolism. Various preventive strategies have been implemented to overcome drug incompatibilities with limited success. This review presents an innovative approach to prevent drug incompatibilities via isolating the incompatible drugs into nanostructures. Key findings Several examples of incompatible drugs may be loaded separately into nanostructures of various types. Physicochemical characteristics and biocompatibility of the nanomaterials that are being utilized to prevent physicochemical incompatibilities should be carefully considered. Conclusions There is a new era of exploiting nanomaterials in overcoming various types of physicochemical incompatibilities, with additional benefits of further improvements in pharmacokinetic profiles and pharmacological actions of the administered drugs.

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“…Physicochemical reactions may impair the therapeutic efficacy of the medicines or result in venous catheter occlusion, toxic compound formation, embolism, or local/systemic inflammatory reactions . There are cases of life threatening pulmonary embolism, ventricular failure, and ineffective therapy in humans, prompting the Food and Drug Association to issue safety alerts . These adverse effects harm patients and increase costs for hospitals .…”

Section: Introductionmentioning

confidence: 99%

Co‐administration of multiple intravenous medicines: Intensive care nurses' views and perspectives

Oduyale

Patel

Borthwick

et al. 2020

Nursing in Critical Care

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Background: Co-administration of multiple intravenous (IV) medicines down the same lumen of an IV catheter is often necessary in the intensive care unit (ICU) while ensuring medicine compatibility.Aims and objectives: This study explores ICU nurses' views on the everyday practice surrounding co-administration of multiple IV medicines down the same lumen.Design: Qualitative study using focus group interviews.Methods: Three focus groups were conducted with 20 ICU nurses across two hospitals in the Thames Valley Critical Care Network, England. Participants' experience of co-administration down the same lumen and means of assessing compatibility were explored. All focus groups were recorded, transcribed verbatim, and analysed using thematic analysis. Functional Resonance Analysis Method was used to provide a visual representation of the co-administration process. Results:Two key themes were identified as essential during the process of co-administration, namely, venous access and resources. Most nurses described insufficient venous access and lack of compatibility data for commonly used medicines (eg, analgesics and antibiotics) as particular challenges. Strategies such as obtaining additional venous access, prioritizing infusions, and swapping line of infusion were used to manage IV administration problems where medicines were incompatible, or of unknown or variable compatibility.Conclusions: Nurses use several workarounds to manage commonly encountered medication compatibility problems that may lead to delays in therapy. Organizations should review and tailor compatibility resources towards commonly administered medicines using an interdisciplinary approach. Developing a clinical decision-making pathway to minimise variability while promoting safe co-administration practice should be prioritised.Relevance to clinical practice: This study highlights several ways ICU nurses are able to manage challenges associated with co-administration and the need for the development of a more robust and comprehensive compatibility resource that is relevant to everyday practice through collaboration between nurses and pharmacists.

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Clinical implications of intravenous drug incompatibilities in critically ill patients

Abstract: Little data is available on this topic. Infused particles may induce organ failure, in particular pulmonary toxicity and SIRS. Further studies are needed to establish a link between the level of exposure to drug incompatibilities and clinical implication.

Cited by 47 publications

References 33 publications

Emulsion Stability of Different Intravenous Propofol Formulations in Simulated Co-Administration with Remifentanil Hydrochloride

Emulsion Stability of Different Intravenous Propofol Formulations in Simulated Co-Administration with Remifentanil Hydrochloride

Nanomedicine: a new paradigm to overcome drug incompatibilities

Co‐administration of multiple intravenous medicines: Intensive care nurses' views and perspectives

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