Aims The Paediatric Intensive Care Unit (PICU) is a unique clinical setting where a wide variety of intravenous medicines are prescribed. Often, limited venous access means that these intravenous solutions need to be given through the same line via a Y-site. Limited published information exists regarding compatibility of intravenous infusions when administered in this way, particularly when more than two drugs are involved. Decisions to Y-site infusions are often made using The Handbook on Injectable Medicines.1 Where this source does not provide compatibility data, pharmacists play an integral role with decisions made based on clinical experience of use without adverse effect in light of little solid scientific data. The Department of Health (DoH) issued a policy in May 2010 regarding the mixing of medicines prior to administration in clinical practice.2 The policy ‘requires organisations to take a proportionate and systematic approach to reviewing mixing practice as patient care could be compromised by unconsidered change in practice’.
In response to the DoH policy, this study reviews current mixing practice on the PICU with the following objectives:
To identify which combinations of drug infusions are commonly administered by ‘mixing’ at a Y-site prior to administration
To identify combinations for which there is insufficient data to support compatibility
To provide background information required to produce a list of acceptable combinations which may be used routinely on the unit.
Methods This project was conducted as a prospective observational study whereby PICU patients receiving intravenous infusions were selected randomly over 6 months. Records were made of infusions being administered and detailed the following:
Name of the continuous drug infusions
Prescribed drug concentrations
Name of non-continuous intravenous drugs
Combination of drugs administered through the same lumen of a central or peripheral line.
Trissel1 was used to search for evidence of compatibility for the Y-sited infusion combinations. The PICU pharmacist reviewed the data with a view to identifying combinations considered safe practice due to clinical experience.
Results 40 patients were reviewed with 47 drug combinations identified. Trissel1 identified that all drug combinations were compatible where data was available; however it only provided data for 33 out of the 47 combinations. 12 out of the 47 identified combinations consisted of drug mixtures containing more than two drug solutions for which Trissel does not provide compatibility data. All combinations were considered safe by the PICU pharmacist.
Conclusions Many intravenous drugs are being administered on the PICU in combination via a Y-site for which there is very limited scientific data to support their compatibility. Their use is considered safe due to clinical experience of use without adverse effect. Future work should involve research into physical and chemical compatibility for commonly prescribed Y-sited combinations to ensure safe practice.