Pharmacist-Led Assessment of Y-Site Compatibility in Pediatric Total Parenteral Nutrition: A Prospective Study of Clinical Practice

Background: Hospital pharmacists are essential for the safe use of total parenteral nutrition (TPN), a complex high-alert medication. Errors may occur during TPN administration; for example, Y-site incompatibilities may cause embolism or thrombosis. Pediatric patients are especially vulnerable because of complex formulations and limited venous access. The stability of both TPN and any drugs administered concurrently depends on physicochemical properties. The American Society for Parenteral and Enteral Nutrition emphasizes the pharmacist's role in preventing such incompatibilities. Objective: To describe the role of pharmaceutical care in, and a systematic approach to, managing Y-site administration of medications with TPN in pediatric patients. Methods: A prospective observational study was conducted from May to October 2024 at a university children's hospital in Madrid, Spain. The study involved hospitalized pediatric patients who were receiving TPN by central venous catheter. A clinical pharmacist evaluated the compatibility of IV drugs with TPN using an evidence-based approach, with information from specialized sources and the literature. Each TPN-drug combination was classified as compatible, incompatible, contradictory, or unknown, and pharmacists' recommendations were documented in the electronic prescription system. Results: A total of 37 patients (accounting for 40 TPN episodes) were included. Their median age was 11 (interquartile range 2.9-12.8) years, and most were receiving oncological care. Pharmacists undertook 604 interventions; 311 (51.5%) involved compatible combinations, 100 (16.6%) involved incompatible combinations, 150 (24.8%) involved combinations lacking data, and 43 (7.1%) involved combinations with contradictory information. Of the 75 drugs that were reviewed, 25 (33.3%) were compatible with TPN, 15 (20.0%) were incompatible, 32 (42.7%) lacked data, and 3 (4.0%) had contradictory reports. Conclusions: Pharmacist-led assessment of Y-site compatibility in pediatric TPN is essential for medication safety and good outcomes. The high proportion of drugs with unknown or conflicting information about compatibility highlights the need for further research to support clinical decision-making.