NP-008 Compatibility of intravenous medications administered via Y-site

<h3>Background and Importance</h3> Intravenous administration is the most common method of drug delivery in intensive care units.¹ Critically ill patients often have limited vascular access, necessitating the administration of multiple medications into the same lumen of the vascular catheter, which increases the risk of incompatibilities. The administration of incompatible medications can have serious consequences for the patient (treatment failure, microembolism, increased toxicity of the drug). For Y-site infusion, the drugs must be both physically and chemically compatible. There is often insufficient information on drug compatibility and where it exists, it is difficult to interpret.² <h3>Aim and Objectives</h3> The aim of the work was to create a table of compatibilities for Y-site administration of intravenous drugs used in our hospital. <h3>Materials and Methods</h3> In collaboration with nurses, we identified the most used medications administered by continuous infusion. The evaluation of compatibility was based on an extensive literature review, included SmPC, ASHP Injectable Drug Information, the Stabilis database and published articles. Due to limited published data, experimental <i>in vitro</i> compatibility testing was performed for several medications. The physical compatibility was assessed by mixing two drugs in 1:1 ratio at the concentrations used in clinical practice in our hospital in duplicates. Mixture was visually compared to the diluent solution using black and white backgrounds (Ph.Eur.2.9.20), immediately after mixing and 10 minutes later. Incompatibility was determined if any of the following occurred: precipitate formation, colour change, cloudiness of the solution. <h3>Results</h3> A total of 30 drugs in 435 combinations were evaluated. Based on the literature review, we were able to identify 108 compatible, three incompatible mixtures of two drugs administered via a Y-site and 21 compatible mixtures only under certain conditions. Experimental <i>in vitro</i> testing was performed for 14 drugs in 67 combinations. We confirmed 59 compatible and eight incompatible mixtures, most often in combination with amiodarone and hydrocortisone. <h3>Conclusion and Relevance</h3> As a result of this project an institutional guideline titled ‘Compatibility of intravenously administered drugs via Y-site’ was implemented in our institution. The purpose is to standardise practices across various departments of the hospital and ensure correct and safe Y-site administration. <h3>References and/or Acknowledgements</h3> Ayari G, <i>et al</i>. Y-site compatibility of IV medications commonly used in ICU: laboratory tests on 75 mixtures involving nine main drugs. <i>Pharmaceutical Technology in Hospital Pharmacy</i> 2022;<b>7</b>(1):80–87. ISSN 2365-2411. Castells Lao G, <i>et al</i>. Compatibility of drugs administered as Y-site infusion in ICU: a systematic review. <i>Medicina Intensiva</i>. 2020;<b>44</b>(2):80–87. ISSN 21735727.