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Compatibility of Neonatal Parenteral Nutrient Solutions with Commonly Used Drugs during Y-site Delivery in NICU

Journal of the Korean Pediatric Society 1998;41(7):893-900.
Published online July 15, 1998.
Compatibility of Neonatal Parenteral Nutrient Solutions with Commonly Used Drugs during Y-site Delivery in NICU
Ju Hun Choi1, Kyong Ju Jeong2, Ha Ryung Cho2, Dong Soo Yim2, Seung Ki Choi2, Kyu Hyung Lee1
1Department of Pediatrics, Pundang CHA General Hospital, Collage of Medicine, Pochon CHA University, Sungnam, Korea
2Department of Pharmacy, Pundang CHA General Hospital, Collage of Medicine, Pochon CHA University, Sungnam, Korea
신생아 집중치료실에서 총정맥영양액과 같은 경로로 투여되는 약물들의 상호 적합성에 관한 연구
최주헌1, 정경주2, 조하령2, 임동수2, 최승기2, 이규형1
1포천중문의과대학 분당차병원 소아과
2분당차병원 약제부
Correspondence: 
Ju Hun Choi, Email: 1
Abstract
Purpose
: Because vascular access sites in neonates are limited, intravenous(IV) medications must often be mixed with maintenance fluids, including parenteral nutrient(PN) solutions. This study was done to determine whether IV medications commonly prescribed in the neonatal in- tensive care unit(NICU) are compatible with the two neonatal PN solutions.
Methods
: The compatibility of neonatal PN solutions and selected other drugs during Y-site delivery was evaluated. Secondary drugs were administered at selected concentrations, rates and delivery by method commonly used at the NICU. Drugs administered by syringe pump over 30min : amikacin, cefotaxime, ceftriaxone, piperacillin, phenytoin, aminophylline, ceftazidime, fluconazole, indomethacin. Drugs administered by IV push : ampicillin+sulbactam, penicillin G potassium, NaHCO3, ranitidine, epinephrine, furosemide, dexamethasone. Drugs administered by IV infusion for at least 60min : acyclovir, amphotericin B, vancomycin, dobutamine, dopamine, doxapram. After each test, the Y injection site and tube below the Y injection site were visually inspected for precipitation and color change. If no particles or color change was detected, the solution was tested and analyzed by a liquid borne particle analyzer(LBPA).
Results
: White precipitate formed immediately after Y-site administration : phenytoin, aminophylline(undiluted solution), ampicillin+sulbactam(undiluted solution). Number of particles observed with LBPA exceeded the KP guideline limit immediately after Y-site administration and white precipitate formed after 3-4 hour : ceftriaxone, NaHCO3(1 : 2 diluted solution).
Conclusion
: These results revealed that several Ⅳ drugs prescribed in NICU formed precipitate and had a color change, when mixed with neonatal TPN solutions.
Key Words: Total parenteral nutrition, Neonatal intensive care unit, Compatibility test


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