Ross Emma L, Petty Kirsten, Salinas Allison, Bremmer Jarrett, Her Cheng, Carpenter John F
Department of Pharmacy (ELR, KP, AS), Children's Hospital Colorado, Aurora, CO.
Department of Pharmacy (JB), University of Colorado Skaggs School of Pharmacy and Pharmaceutical Science, Aurora, CO.
J Pediatr Pharmacol Ther. 2023;28(1):84-92. doi: 10.5863/1551-6776-28.1.84. Epub 2023 Feb 3.
To evaluate the physical intravenous Y-site compatibility of 29 combinations of medications at commonly used pediatric concentrations using both existing and novel techniques.
Medication combinations included were selected by a varied group of pediatric inpatient pharmacists, and then assessed by 3 independent reviewers for existing literature. For each combination, 2 different medications were mixed together in a 1:1 ratio and incubated at room temperature for 4 hours to simulate Y-site administration. Each sample was then analyzed using the US Pharmacopeia (USP) <788> recommended analytical technique of light obscuration (LO) in addition to novel flow imaging (FI) microscopy and backgrounded membrane imaging (BMI). Physical compatibility was determined using USP chapter <788> large volume particle count limits for all techniques.
A total of 29 different medication combinations were studied. Five combinations met criteria for compatibility by all 3 techniques. The remaining 24 combinations reached the threshold to be considered incompatible by at least 1 of the 3 techniques. Light obscuration, BMI, and FI identified 14%, 59%, and 76% of combinations as incompatible, respectively. All samples deemed incompatible by LO were also incompatible by at least 1 of the other 2 techniques. Flow imaging and BMI results agreed in 69% of samples tested.
Most combinations tested were found to be incompatible by at least 1 of the 3 instruments used. Light obscuration appears to have reduced accuracy for identifying particulate resulting in physical medication incompatibility when compared with the novel techniques of FI and BMI.
运用现有技术和新技术，评估29种常用儿科浓度药物组合在静脉Y型接口处的物理相容性。
药物组合由不同的儿科住院药师团队选定，然后由3名独立评审员评估现有文献。对于每种组合，将2种不同药物按1:1比例混合，在室温下孵育4小时以模拟Y型接口给药。然后，除了采用新型流动成像（FI）显微镜和背景膜成像（BMI）外，每个样品还使用美国药典（USP）<788>推荐的光阻法（LO）分析技术进行分析。所有技术均使用USP第<788>章大容量颗粒计数限值来确定物理相容性。
共研究了29种不同的药物组合。5种组合在所有3种技术下均符合相容性标准。其余24种组合至少在3种技术中的1种下达到了被视为不相容的阈值。光阻法、BMI和FI分别将14%、59%和76%的组合鉴定为不相容。所有被光阻法判定为不相容的样品在其他2种技术中至少有一种下也不相容。流动成像和BMI结果在69%的测试样品中一致。
在所使用的3种仪器中，至少有1种仪器检测到大多数测试组合不相容。与FI和BMI等新技术相比，光阻法在识别导致药物物理不相容的颗粒方面准确性似乎较低。
