Y site compatibility

Added: Hayley Bise - Date: 12.04.2022 06:01 - Views: 30476 - Clicks: 1784

All works go through a rigorous selection process. The Impact Factor measures the average of citations received in a particular year by papers published in the journal during the two preceding years. SRJ is a prestige metric based on the idea that not all citations are the same. SJR uses a similar algorithm as the Google rank; it provides a quantitative and qualitative measure of the journal's impact.

SNIP measures contextual citation impact by wighting citations based on the total of citations in a subject field. To gather all published information about the stability of drugs commonly used in Intensive Care Units ICU ; evaluate the methodology of published data; and generate a compatibility table..

Articles published from to in English, Spanish and French were included. Spanish and international hospital ICU.. The systematic review included 29 studies 27 originals, 2 reviews. None of the included studies followed all the methodological requirements.

Accordingly, drug stability knowledge was available for This review provides new reliable evidence about the physicochemical stability of drugs commonly used in the critical care setting. The study contributes to the safe administration of intravenous drugs in critical patients with a view to avoiding adverse events in this frail population.. Vasoactive drugs, analgesics, and sedatives are among the most widely used therapeutic groups and are usually administered in continuous infusion.

According to the systematic review conducted by Moyen et al. Errors in the administration of drugs in ICUs are due to several factors: the use of high-risk drugs vasoactive drugs, inotropes, sedatives, etc. Another factor is the prescription of doses in different units of measurement or the high of drugs used with each patient. Although it is an important advance with regard to safety, the use of intelligent infusion pumps has been associated with an important or medication errors due to programming issues.

The combination of these risk factors increases the chances of making mistakes in the most vulnerable patients due to their severity. Critically ill patients often have limited venous accesses. This means that different drugs are delivered using the same route of administration, which increases the risks involved when mixing incompatible drugs. The mix of incompatible drugs is a medication error that can have serious consequences for the patient such as therapeutic failures, micro-embolism or toxicity. The Y-site infusion of 2 drugs requires both drugs to be physically compatible. On the other hand, for the safe coadministration of 2 drugs in the same diluent, the mix needs to be chemically stable.

This means prior confirmation is needed that no ificant change has occurred in the concentration of either one of the drugs present in the mix. Standardizing the concentration of infusion solutions is one of the most useful measures to prevent medication errors in the ICU setting, especially in high-risk drugs due to their potential to cause severe damage and because they have the highest incidence of medication errors.

Another highly recommended measure for the safe administration of drugs is having reliable information available on drug compatibility when administering common drugs in critically ill patients. However, information on drug compatibility is scarce and, on many occasions, difficult to interpret due to the different concentrations used, the lack of information on the assessment techniques used or the suspicious technical quality of the sources.

The lack of information on the safe mix of 2 drugs creates problems in the daily work of ICU nursing teams. Added to the risk of complications associated to the administration of 2 incompatible molecules, this lack of information can make the nurse have to look for new venous accesses to administer the drugs separately whichincreases the risk of infectious or thromboembolic complications. The goal of this review is to gather the information published on the physical and chemical compatibility of the most commonly used drugs at an ICU when infused through the same line via a Y-site.

Also, to assess the quality of the information published and generate a compatibility chart with reliable and updated information to improve safety in the administration of drugs to critically ill patients. A systematic search on Medline, Stabilis, Handbook on Injectable Drugs, and Micromedex databases was conducted for the identification of original papers, review articles and meta-analyses on the physical and chemical compatibility of drugs.

Due to their clinical approach and lack of methodology to determine physical and chemical stability, case studies were discarded. The reviews published by Kanji et al. Search focused on drug combinations on which these authors had no information or had not looked for information.

The years of publication of the studies went from thes until December and the languages included were English, Spanish, and French. The terms used were physical compatibility, drug stability, y-site, y-injection, intravenous drug, plus the names and synonyms of the drugs of interest. The drugs used in the review are routinely used in the ICU setting are often administered by continuous infusion. The concentrations used as a reference are the ones standardized in our center 7 for these drugs and are consistent with the ones commonly used in most ICUs Table 1.

All information on compatibility found for a certain molecule about a different concentration interval is shown in Table 2. The reference search process for each drug was conducted concurrently by 2 independent researchers. Study drugs and concentrations used as reference for the bibliographic search. Combinations of physical and chemically compatible drugs with concentrations below the reference mark. After the reference search, 2 independent reviewers assessed the quality of the studies using a peer-review process. This review was conducted following quality criteria based on the opinion of experts and following clinical practice guidelines 8—11 : 1.

Study reproducibility: description of active ingredient and diluent, study conditions and methodology. of tests run at least in triplicate. Times elapsed while taking the samples in the stability analysis: a 5-time sample time period is recommended including a sample time of 0. Studies conducted to assess the stability of the mix: a transparency: for visible particles, observation with a matt black panel, automatic particle count or turbidimetry; for subvisible particles, use of optic microscopy, spectrophotometry or turbidimetry; b change in color: visual inspection or spectrophotometry; c gas formation: visual inspection; d pH; and e chemical stability: measurement of the variation of the concentration of the 2 drugs.

A chart was created with all the possible combinations of the drugs of interest. The drug combination with no compatibility data were left unchecked. A total of 48 papers were identified. Out of the 29 papers included in the review, 4 were written in Spanish, 3 in French, and 22 in English. Regarding the dates of publication, 8 papers were published between and , 10 between and , and the remaining 11 papers were published between and Structured summary of the of the reference search.

None of the papers studied met all of the quality criteria established in this review. Only 6 studies assessed the chemical stability of the mixes being high-resolution liquid chromatography the method used in 5 studies to measure the concentration of the active ingredients of the mix.

The on this section are summarized in Table 3. Summary of the quality criteria of the papers published. Forty-four drugs used in continuous perfusion at the ICU setting were selected including a solution for parenteral nutrition with and without lipids and 3 beta-lactam antibiotics.

The compatibility of these is shown in Fig. The data obtained by the reviews conducted by Kanji et al. The new findings revealed 29 compatible combinations, 27 incompatible combinations, and 26 compatible combinations in specific conditions. Therefore, the final table shows the compatibility data of out of possible combinations of 2 drugs Of these, are compatible Summary of physical and chemical compatibilities.

Dotted boxes show that the mix is compatible with glycosylated serum only. Boxes with diagonal lines show compatibility with physiological serum only. Making sure that the use of drugs is safe is one of the main commitments made by healthcare providers with their patients. Online databases like Stabilis 4. However, the personnel administering the drugs finds charts much more useful because they can quickly look at the information they need at a given time. This is especially interesting in urgent situations when any delays caused by the healthcare providers can have consequences in the patient.

This review focused on analyzing the physical and chemical compatibility of the IV drugs most commonly used through Y-site infusion in the ICU setting and summarizing the information obtained in a double-entry chart. Physical compatibility studies are the most common of all because they are easy to conduct. Chemical stability studies, however, are not because they require more sophisticated analytical techniques to determine the initial and final concentration of drugs. Despite this, the of drug combinations studied is still insufficient. As Fig.

Even if we took all the possible combinations suggested into consideration and added the new data found, we would still have zero information on the physical and chemical compatibility of combinations. This means that we only have data available for The most problematic combinations regarding incompatibility are drugs whose stability is closely linked to the pH interval; this is the case with sodium bicarbonate, furosemide or pantoprazole. Furosemide, for example, requires a basic pH to guarantee the stability of the molecule in solution, which is why the mix with acid drugs pH 4 causes turbidity and precipitation.

The presence of adjuvants in the pharmaceutical formulation, the concentration and exposure to extreme temperatures or luminosity are other factors associated with drug incompatibility. Thus, if this allegedly compatible mix is performed in physiological serum, a loss of concentration of amiodarone can occur with the corresponding risk of lack of therapeutic response. On the other hand, in many cases, the quality of the studies published so far can be better. It would be good to have greater uniformity in the quality standards of this type of studies.

For example, even though the pH is a critical factor in the stability of drugs in solution, it was only verified in 12 of the 27 papers. Similarly, turbidimetry or microscopy—more accurate techniques than visual observation for the detection of particles and changes in color—are underused. Over the last few years, several experts have published guidelines for the de of drug stability studies. Former authors have published reviews of these characteristics. For instance, Flamein et al. Our review is based on the work done by Kanji et al.

It has been completed with the new information available on drugs in our setting and data on the most widely used concentrations of drugs. Overall, we found information on 82 new drug combinations from 27 different references including combinations of 3 beta-lactam antibiotics ceftazidime, meropenem, and piperacillin-tazobactam widely used at the ICU setting.

Over the last few years the pharmacokinetic advantages of a prolonged perfusion route of administration of these 3 antibiotics have been confirmed. Perfusions at drug concentrations that exceed the usual ones are often used in the critically ill patient.

In this sense, we could not find data on all drug combinations regarding the high concentrations used in the ICU setting Table 1 ; however, in some cases, we did obtain information on lower concentrations than the ones reported in this review. These cases are shown on the compatibility chart Fig. The stability data reported in this review cannot be generalized to other drug combinations or concentrations different from the ones described. Nevertheless, the drugs and concentrations selected are the most widely used in the adult ICUs of most hospitals. Until we have new and better compatibility studies that shed some light on this issue, this review can be an easy-to-read update on the evidence available on the compatibility of the drugs most commonly used at the ICU setting.

Its goal is to contribute to the safe administration of drugs to patients who can face the consequences of greater severity due to their frailty. Judit Roura Turet: data mining, analysis and interpretation of data; paper draft or critical review of the intellectual material; and final approval of this version. Marta Prat Dot: data mining, analysis and interpretation of data; paper draft or critical review of the intellectual material; and final approval of this version.

Dolors Soy Muner: study de and idea; paper draft or critical review of the intellectual material; and final approval of this version. The authors declared no conflicts of interest whatsoever.

Y site compatibility

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IV Compatibility