Y-site injection compatibility of parenteral medicines with balanced salt solutions

Background and importance
Simultaneous administration of multiple infusion solutions (Y-site administration) via the same catheter lumen is not avoidable in clinical practice of intensive care patients. Compatibility of simultaneously administrated infusions is a prerogative for medication safety. However, information about Y-site compatibility is often not available. This is especially true for simultaneously administered balanced salt solutions, which are indicated for fluid therapy. Moreover, different types of (brand)products contain different types and quantities of electrolytes.

Aim and objectives
The aim of this study was to evaluate compatibility information of commonly used parenteral medicines with different types of balanced salt solutions and Ringer’s lactate injection during Y-site infusion (1:1 mixture). Results should be presented in printed table format and in an electronic data base.

Materials and methods
A systematic literature review was performed regarding the compatibility of balanced salt solutions, i.e. Elektrolyt-Infusionslösung 153 (Burg Pharma), Jonosteril^® (Fresenius Kabi), Normosol®-R (ICU Medical), Sterofundin^® ISO (BBraun Melsungen) and Ringer’s lactate injection with 194 parenteral medicines used in our hospital. Data were retrieved from the Summary of Product Characteristics, Stabilis^®, Trissel’sTM IV Compatibility, and KIK (B.Braun) databases. A literature search was performed in PubMed and GoogleScholar. Y-site compatibility of the 1:1 mixtures was summarized in the table as possibly in-/compatible and probably in-/compatible. In the ADKA-STABIL-Datenbank, compatibility information for each combination was documented and categorized as in-/compatible.

Results
Usable Y-site compatibility information regarding balanced salt solutions was retrievable for 97 out of 194 pre-selected medicines, showing (brand)product specific in-/compatibility. Results were compiled in table format listing the different types of (balanced) salt solutions and the medicines in question. Categories were assigned and marked together with references. For the other 97 medicinal products compatibility information was missing or contradictory. Monographs were compiled for Jonosteril®, Sterofundin^® ISO and Ringer’s lactate injection in the ADKA-STABIL-Datenbank encompassing 459 compatibility data sets.

Conclusion and relevance
Although compatibility information based on experimental studies is limited for the different (brand)products, 97 medicines could be categorized. Detailed information is accessible in table format in a publication and new monographs in a stability data base. Further experimental studies are required to complete missing compatibility information.

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