Aysel PEHLİVANLI, Çiğdem ÖZGÜN, Çağatay Fikret ERAD, Arif Tanju ÖZÇELİKAY, Mustafa Necmettin ÜNAL

Yoğun Bakımda İntravenöz Uygulanan İlaçlarda Geçimsizlik, Y-Parçası Geçimsizliği ve Geçimsizlik Yönetimi

Yoğun Bakım Ünitesi’nde (YBÜ), ilaçların oral formları yerine intravenöz (IV) formları daha çok tercih edilmektedir. Hastalar genellikle santral venöz kateter yoluyla uygulanan çok sayıda IV ilaç kullanmaktadır, bu nedenle IV ilaç uygulamaları aynı anda uygulanan ilaçların sayısının mevcut venöz hatların sayısından fazla olabilmesi nedeniyle komplekstir. Yoğun bakım ünitesindeki ilaçlarla ilgili problemlerin yaklaşık %19’unun ilaç geçimsizliğinden kaynaklandığı bildirilmektedir. Geçimsizlik sonucu meydana gelen komplikasyonlar arasında, santral venöz kateterde tıkanma ya da malfonksiyon, kristalizasyon veya ayrılmadan kaynaklanan partikül embolisi, terapötik başarısızlık ve lokal ya da sistemik inflamatuar reaksiyonlar yer almaktadır. Bu nedenle YBÜ’de IV yolla ilaç uygulamalarında geçimsizlik, Y-parça geçimsizliği ve yönetimi konusunda farkındalık oluşturulması önem taşımaktadır.

Incompatibility, Y-Site Incompatibility and Incompatibility Management forIntravenously Administered Drugs in Intensive Care Unit

In the Intensive Care Unit (ICU), the intravenous (IV) forms of drugs are preferred more than their oral forms. Patients are using many IV drugs administered with a central venous catheter, so IV drug administration is complex because the number of drugs administered simultaneously may be greater than the number of venous lines available. It has been reported that nearly 19% of drugrelated problems in the ICU are caused by drug incompatibility. Complications due to incompatibility include central venous catheter occlusion or malfunction, particle embolism due to crystallization or detachment, therapeutic failure, and local or systemic inflammatory reactions. For this reason, it is important to raise awareness about incompatibility, Y-site incompatibility, and management in ICU.

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1. Sriram S, Aishwarya S, Moithu A, Sebastian A, Kumar A. Intravenous drug incompatibilities in the intensive care unit of a tertiary care hospital in India: Are they preventable? J Res Pharm Pract 2020;9(2):106-11.
2. Benlabed M, Perez M, Gaudy R, et al. Clinical implications of intravenous drug incompatibilities in critically ill patients. Anaesth Crit Care Pain Med 2019;38(2):173-80.
3. Fekadu T, Teweldemedhin M, Esrael E, Asgedom SW. Prevalence of intravenous medication administration errors: A cross‑sectional study. Integr Pharm Res Pract 2017;6:47‑51.
4. Kanji S, Lam J, Johanson C, et al. Systematic review of physical and chemical c ompatibility of commonly used medications administered by continuous infusion in intensive care units. Crit Care Med 2010;38(9):1890-8.
5. Maison O, Tardy C, Cabelguenne D, et al. Drug incompatibilities in intravenous therapy: Evaluation and proposition of preventive tools in intensive care and hematology units. Eur J Clin Pharmacol 2019;75(2):179-87.
6. Newton DW. Drug incompatibility chemistry. Am J Health Syst Pharm 2009;66:348-57.
7. Chantelau E, Lange G, Gasthaus M, Boxberger M, Berger M. Interaction between plastic catheter tubings and regular insulin preparations used for continuous subcutaneous insulin-infusion therapy. Diabetes Care 1987;10(3):348-51.
8. Vueba ML, Veiga F, Sousa JJ, Pina ME. Compatibility studies between ibuprofen or ketoprofen with cellulose ether polymer mixtures using thermal analysis. Drug Dev Ind Pharm 2005;31(10):943-9.
9. Newton DW. Y-site compatibility of intravenous drugs with parenteral nutrition. J Parenter Enter Nutr 2012;37(3):297-9.
10. Lumpkin MM. Safety alert: Hazards of precipitation associated with parenteral nutrition. Am J Hosp Pharm 1994;51(11):1427-8.
11. Research Center for Drug Evaluation and Information for Healthcare Professionals: Ceftriaxone (marketed as Rocephin) 9 /2007. Available from: https://www.fda.gov/ drugs/postmarket-drug-safety-information-patients-andproviders/UCM134328. Available date: 31/03/2021.
12. Jack T, Boehne M, Brent BE, et al. In-line filtration reduces severe complications and length of stay on pediatric intensive care unit: A prospective, randomized, controlled trial. Intensive Care Med 2012;38(6):1008-16.
13. Boehne M, Jack T, Köditz H, et al. In-line filtration minimizes organ dysfunction: New aspects from a prospective, randomized, controlled trial. BMC Pediatr 2013;13:21.
14. McNearney T, Bajaj C, Boyars M, et al. Total parenteral nutrition associated crystalline precipitates resulting in pulmonary artery occlusions and alveolar granulomas. Dig Dis Sci 2003;48(7):1352-4.
15. Hardy G, Ball P. Clogbusting: Time for a concerted approach to catheter occlusions? Curr Opin Clin Nutr Metab Care 2005;8(3):277-83.
16. Micromedex® IV Compatibility. Available from: https:// www.micromedexsolutions.com/micromedex2/librarian/ CS/C8DAB0/ND_PR/evidencexpert/ND_P/evidencexpert/ DUPLICATIONSHIELDSYNC/05DFAE/ND_PG/evidencexpert/ ND_B/evidencexpert/ND_AppProduct/evidencexpert/ ND_T/evidencexpert/PFActionId/evidencexpert. FindIVCompatibility?navitem=topIV&isToolPage=true. Available date: 20/02/2022.
17. Bradley JS, Wassel RT, Lee L, Nambiar S. Intravenous ceftriaxone and calcium in the neonate: Assessing the risk for cardiopulmonary adverse events. Pediatrics 2009;123(4):e609-13.
18. Barranco Ruiz F, Sa´nchez Alarco´n MA, Lesmes Serrano A, Martı´nez Ruiz D, Barranco Sa´nchez R. Loss of intravenous nitroglycerin administered with polyvinyl chloride infusion systems. Med Clin 1991;96(4):129-31.
19. De Muynck C, Vandenbossche GM, Colardyn F, Remon JP. Sorption of isosorbide dinitrate to central venous catheters. J Pharm Pharmacol 1993;45(2):139–41.
20. Yliruusi JK, Uotila JA, Kristoffersson ER. Effect of flow rate and type of i.v. container on adsorption of diazepam to i.v. administration systems. Am J Hosp Pharm 1986;43(11):2795- 9.
21. Kowaluk EA, Roberts MS, Polack AE. Interactions between drugs and intravenous delivery systems. Am J Hosp Pharm 1982;39(3):460-7.
22. Henton DH, Merritt RJ. Vitamin A sorption to polyvinyl and polyolefin intravenous tubing. JPEN J Parenter Enteral Nutr 1990;14(1):79-81.
23. Zahid N, Taylor KMG, Gill H, Maguire F, Shulman R. Adsorption of insulin onto infusion sets used in adult intensive care unit and neonatal care settings. Diabetes Res Clin Pract 2008;80(3):e11-3.
24. Hewson M, Nawadra V, Oliver J, Odgers C, Plummer J, Simmer K. Insulin infusions in the neonatal unit: Delivery variation due to adsorption. J Paediatr Child Health 2000;36(3):216- 20.
25. Muhlebach S. İlaçlar ve beslenme ürünlerinin karışımları. İçinde: Sobotka L, editör. Klinik Nutrisyon Temel Kavramlar Kitabı. İkinci baskı. İstanbul: Logos Yayıncılık, 2004;263-9.
26. Bertsche T, Mayer Y, Stahl R, Hoppe-Tichy T, Encke J, Haefeli WE. Prevention of intravenous drug incompatibilities in an intensive care unit. Am J Health Syst Pharm 2008;65(19):1834- 40.
27. Gikic M, Di Paolo ER, Pannatier A, Cotting J. Evaluation of physicochemical incompatibilities during parenteral drug administration in a paediatric intensive care unit. Pharm World Sci 2000;22(3):88-9.
28. Tissot E, Cornette C, Demoly P, Jacquet M, Barale F, Capellier G. Medication errors at the administration stage in an intensive care unit. Intensive Care Med 1999;25(4):353-9.
29. Leopoldino RW, Costa HT, Costa TX, Martins RR, Oliveira AG. Potential drug incompatibilities in the neonatal intensive care unit: A network analysis approach. BMC Pharmacol Toxicol 2018;19(1):83.
30. Kanji S, Lam J, Goddard RD, et al. Inappropriate medication administration practices in Canadian adult ICUs: A multicenter, cross-sectional observational study. Ann Pharmacother 2013;47(5):637-43.
31. King Guide to Parenteral Admixtures®. Available from: https://www.kingguide.com/index.html. Available date: 20/02/2022.
32. Stabilis. Available from: https://www.stabilis.org/. Available date: 20/02/2022.
33. Foinard A, Décaudin B, Barthélémy C, Debaene B, Odou P. The impact of multilumen infusion devices on the occurrence of known physical drug incompatibility: A controlled in vitro study. Anesth Analg 2013;116(1):101-6.
34. Collins JL, Lutz RJ. In vitro study of simultaneous infusion of incompatible drugs in multilumen catheters. Heart Lung 1991;20(3):271-7.
35. Perez M, Décaudin B, Foinard A, et al. Compatibility of medications during multi-infusion therapy: A controlled in vitro study on a multilumen infusion device. Anaesth Crit Care Pain Med 2015;34(2):83-8.
36. Perez M, Décaudin B, Abou Chahla W, et al. In vitro analysis of overall particulate contamination exposure during multidrug IV therapy: Impact of infusion sets. Pediatr Blood Cancer 2015;62(6):1042-7.
37. Foinard A, Décaudin B, Barthélémy C, Debaene B, Odou P. Prevention of drug delivery disturbances during continuous intravenous infusion: An in vitro study on a new multilumen infusion access device. Ann Fr Anesth Reanim 2013;32(9):e107-12.
38. Décaudin B, Dewulf S, Lannoy D, et al. Impact of multiaccess infusion devices on in vitro drug delivery during multiinfusion therapy. Anesth Analg 2009;109(4):1147-55.
39. LeDuc K. Efficacy of normal saline solution versus heparin solution for maintaining patency of peripheral intravenous catheters in children. J Emerg Nurs 1997;23(4):306-9.
40. Bertsche T, Veith C, Stahl A, et al. A purging procedure for pantoprazole and 4-lumen catheters to prevent IV drug incompatibilities. Pharm World Sci 2010;32(5):663-9.
41. Isemann B, Sorrels R, Akinbi H. Effect of heparin and other factors associated with complications of peripherally inserted central venous catheters in neonates. J Perinatol 2012;32(11):856-60.
42. Ball PA. Intravenous in-line filters: Filtering the evidence. Curr Opin Clin Nutr Metab Care 2003;6(3):319-25.
43. Négrier L, Mena AM, Lebuffe G, Odou P, Genay S, Décaudin B. Strategies to prevent drug incompatibility during simultaneous multi-drug infusion in intensive care units: A literature review. Eur J Clin Pharmacol 2021;77(9):1309-21.
44. Nemec K, Kopelent-Frank H, Greif R. Standardization of infusion solutions to reduce the risk of incompatibility. Am J Health Syst Pharm 2008;65(17):1648-54.
45. Vogel Kahmann I, Bärki R, Denzler U, Höfler A, Schmid B, Splisgardt H. Incompatibility reactions in the intensive care unit. Five years after the implementation of a simple "colour code system". Anaesthesist 2003;52(5):409-12 (in German).