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

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.