Management of Y-Site Incompatibility of Intravenous Medication: A Scoping Review
Keywords:
intravenous incompatibility, compatibility chart, flushing, filter, multi-lumen
Abstract
Patients in intensive care units have a critical problem with Intravenous (IC) drug administration. The effort to decrease incompatibility or manage the incompatibility risks is paramount significant to reduce morbidity and mortality. This review collates all published studies about kinds of approaches to prevent or solve y-site incompatibility, evaluate the effectiveness of those approaches, and provide the recommendation. A scoping review was conducted in PUBMED in a time frame 1 Januari 2010- 28 February 2021. All type studies of randomised controlled trials, observational studies, before and after studies, also review articled were considered to include. We identified 944 studies; of these, 78 met the inclusion criteria, but 44 were excluded. A total 34 articles were included in the analyses. Six articles reported protocol, two-dimensional chart, database, or pH colour code to provide information of incompatibilities. Two-dimensional chart and pH code were comparable with a gold standard. Specific protocol markedly reduced the incompatibility event. Normal saline (NS) flushing effectively prolonged patency and reduced the incompatibility rate. NS was preferred over heparin associated with thrombocytopenia. In-line filtration has been proved to reduce particulate matter, as well as the precipitation, resulted from incompatibility. The filter also reduced inflammation, infection, and complication appreciably. Four studies used more than three lumen catheters which successfully decrease the number of precipitation and incompatibility events. Therefore, separating incompatible drugs using multi-lumens according to the chart should be preferred. However, when co-administration is inevitable, flushing or filter is needed.
References
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Greinacher, A., Juhl, D., Strobel, U., Wessel, A., Lubenow, N., Selleng, K., Eichler, P., & Warkentin, T. E. (2007). Heparin-induced thrombocytopenia: A prospective study on the incidence, platelet-activating capacity and clinical significance of antiplatelet factor 4/heparin antibodies of the IgG, IgM, and IgA classes. Journal of Thrombosis and Haemostasis, 5(8), 1666–1673. https://doi.org/10.1111/j.1538-7836.2007.02617.x
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Han, S. S., Park, J. E., Kim, N. E., & Kang, H. J. (2012b). Effects of Normal Saline for Maintenance of Arterial Lines of Surgical Patients. Journal of Korean Academy of Nursing, 42(6), 791. https://doi.org/10.4040/jkan.2012.42.6.791
Hanifah, S. (2016). The Compatibility of multiple intravenoys intravenoys (IV) drugs administered simultaneously [Charles Sturt Unviersity]. https://researchoutput.csu.edu.au/files/9318294/88572
Hanifah, S., Ball, P., & Kennedy, R. (2018). Medication incompatibility in intravenous lines in a paediatric intensive care unit (PICU) of Indonesian hospital. Critical Care and Shock, 21(3), 118–127. http://criticalcareshock.org/2018/08/
Hoff, R., Vervisch, K., De Coen, K., & Smets, K. (2019). Continuous infusion vs. intermittent flushing of peripheral cannulas in neonates using a needleless connector: A prospective cohort study. Journal of Perinatal Medicine, 47(4), 464–469. https://doi.org/10.1515/jpm-2018-0285
Jack, T., Boehne, M., Brent, B. E., Hoy, L., Köditz, H., Wessel, A., & Sasse, M. (2012). In-line filtration reduces severe complications and length of stay on pediatric intensive care unit: A prospective, randomized, controlled trial. Intensive Care Medicine, 38(6), 1008–1016. https://doi.org/10.1007/s00134-012-2539-7
Jack, T., Brent, B. E., Boehne, M., Müller, M., Sewald, K., Braun, A., Wessel, A., & Sasse, M. (2010). Analysis of particulate contaminations of infusion solutions in a pediatric intensive care unit. Intensive Care Medicine, 36(4), 707–711. https://doi.org/10.1007/s00134-010-1775-y
Kanji, S., Lam, J., Johanson, C., Singh, A., Goddard, R., Fairbairn, J., Lloyd, T., Monsour, D., & Kakal, J. (2010). Systematic review of physical and chemical compatibility of commonly used medications administered by continuous infusion in intensive care units. Critical Care Medicine, 38(9), 1890–1898. https://doi.org/10.1097/CCM.0b013e3181e8adcc
Ku, H., Kim, J., … S. K.-J. of, & 2010, U. (2010). Meta-analysis of Inline Filtration Effects on Post-infusion Phlebitis Caused by Particulate Contamination of Intravenous Administration. Journal of Pharmaceutical Investigation, 40(4), 225–230. https://doi.org/10.4333/kps.2010.40.4.225
Kumar, M., Vandermeer, B., Bassler, D., & Mansoor, N. (2013). Low-dose heparin use and the patency of peripheral IV catheters in children: A systematic review. In Pediatrics (Vol. 131, Issue 3, pp. e864–e872). American Academy of Pediatrics. https://doi.org/10.1542/peds.2012-2403
Langille, S. E. (2013). Particulate Matter in Injectable Drug Products. PDA Journal of Pharmaceutical Science and Technology, 67, 186–200. https://doi.org/10.5731/pdajpst.2013.00922
Lao, G. C., Reyes, M. R., Turet, J. R., Dot, M. P., Muner, D. S., & Cabezas, C. L. (2019). Compatibility of drugs administered as Y-site infusion in intensive care units : A systematic review. Medicina Intensiva (English Edition), xx. https://doi.org/10.1016/j.medine.2018.08.008
Levine, D. M., Garden, A. L., Truong, H. T., Bergemann, J., & Eames, P. (2013). Influence of multi-lumen extensions on fluid flow through intravenous cannulae. Anaesthesia, 68(12), 1239–1242. https://doi.org/10.1111/anae.12443
Maison, O., Tardy, C., Cabelguenne, D., Parat, S., Ducastelle, S., Piriou, V., Lepape, A., & Lalande, L. (2019). Drug incompatibilities in intravenous therapy: evaluation and proposition of preventive tools in intensive care and hematology units. In European Journal of Clinical Pharmacology (Vol. 75, Issue 2, pp. 179–187). Springer Verlag. https://doi.org/10.1007/s00228-018-2602-6
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Published
2022-09-28
How to Cite
Hanifah, S., Ball, P., & Kennedy, R. A. (2022). Management of Y-Site Incompatibility of Intravenous Medication: A Scoping Review. Indonesian Journal of Pharmacy, 33(3), 353-365. https://doi.org/10.22146/ijp.2262
Issue
Section
Review Article
