Drug incompatibilities in intravenous therapy: evaluation and proposition of preventive tools in intensive care and hematology units

Maison, O.; Tardy, Cléa; Cabelguenne, Delphine; Parat, S.; Ducastelle, Sophie; Piriou, Vincent; Lepape, Alain; Lalande, Laure

doi:10.1007/s00228-018-2602-6

Cited by 30 publications

(43 citation statements)

References 26 publications

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“…Participants managed these through workarounds such as requesting additional venous access, prioritising infusions, swapping line of infusion, and changing the form of medicine. These have also been identified in other studies . Workarounds are alternative work procedures devised to circumvent a perceived workflow block, which may become necessary for tasks to be accomplished safely in variable environments such as health care .…”

Section: Discussionmentioning

confidence: 91%

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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Section: Discussionmentioning

confidence: 91%

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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“…Other recent studies performed in adult patients exposed to multiple IV drugs have found incompatible combinations in 12% to 56%. 19,20 However, these differences can be explained using different references and methods. Contrary to other similar studies, we did not exclude any drugs or infusions (i.e., we collected data of all continuous infusions, including electrolytes, PN, and blood products).…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Incompatible Coadministration of Continuous Intravenous Infusions in a Pediatric/Neonatal Intensive Care Unit

Häni

Vonbach

Fonzo-Christe

et al. 2019

The Journal of Pediatric Pharmacology and Therapeutics

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OBJECTIVES We aimed to evaluate and quantify incompatible coadministrations of continuous intravenous medication in the daily clinical practice of a PICU/NICU. METHODS We conducted a retrospective, observational study in the setting of an 18-bed PICU/NICU. All concurrently administered continuous infusions, including blood products and parenteral nutrition, were analyzed for 2 months. Raw electronic data were retrieved and subjected to quality controls. Infusion combinations were classified as compatible, incompatible, no data, or variable according to the internal hospital charts, Trissel's database, and the Swiss summary of product characteristics. For situations with incompatible coadministrations, we assessed alternative distributions of infusions among the currently available lumen. RESULTS Data for 100 patients were analyzed. Patients were exposed to a mean of 6.9 ± 3.6 individual continuous infusions administered through 3.8 ± 1.8 lumina. Among the 1447 coadministered continuous infusions, we detected 146 incompatible combinations (10%), resulting in 105 individually relevant incompatible situations. Furthermore, 185 combinations (13%) were not covered by internal compatibility charts, and for 207 combinations (15%) no data on compatibility were available. We found that 58% of the incompatible situations could have been avoided by a redistribution of the infusions among the available lumina. CONCLUSIONS Most infusion combinations in the studied PICU/NICU were compatible and covered by the internal compatibility charts. However, we also identified concurrent administrations of incompatible infusions or for which compatibility data are not available. A significant reduction of coadministrations of incompatible infusions could be achieved through optimal use of available lumina.

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“…Chemical drug incompatibilities are often sub-visible and lead to chemical degradation of a drug, loss of drug potency and/or the formation of toxic by-products. [13] Physicochemical interactions are not only dependent on the drugs themselves, but also they can be influenced by other factors, including concentrations of the drugs, type of the infusion solution, order of mixing, temperature, storage vehicle and route of administration. [14] Several mechanisms can be involved in physical incompatibilities, including acid-base reactions, ionic interactions, dilution-related incompatibilities, gas-generating reactions and cracking of emulsions.…”

Section: Drug Incompatibilities: a Dilemma In Clinical Practicementioning

confidence: 99%

“…[14] Several mechanisms can be involved in physical incompatibilities, including acid-base reactions, ionic interactions, dilution-related incompatibilities, gas-generating reactions and cracking of emulsions. [13] Acid-base reaction is the most common mechanism of drug incompatibilities since more than 90% of medications are organic weak electrolytes. These reactions frequently occur among drugs that are reconstituted as injections in ionized or salt form.…”

Section: Drug Incompatibilities: a Dilemma In Clinical Practicementioning

confidence: 99%

“…[2,38] Catheter obstruction, loss of drug efficacy and therapeutic failure are well-documented consequences of incompatible drug administration via the same line. [13,39] Life-threatening complications of drug incompatibilities might include tissue ischaemia, hypoxia, tissue irritation, thrombophlebitis and pulmonary embolism. [27,40] The patient's condition (age, weight, severity of the disease, etc.)…”

Section: Complications Of Drug Incompatibilitiesmentioning

confidence: 99%

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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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Drug incompatibilities in intravenous therapy: evaluation and proposition of preventive tools in intensive care and hematology units

Cited by 30 publications

References 26 publications

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

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

Evaluation of Incompatible Coadministration of Continuous Intravenous Infusions in a Pediatric/Neonatal Intensive Care Unit

Nanomedicine: a new paradigm to overcome drug incompatibilities

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