The compatibility of various secondary additives with selected intravenous admixtures at the Y-injection site of an intravenous administration set was studied. The mixing volume of the secondary additive and the i.v. admixture at the Y-injection site to the needle tip was found to occur approximately in a 1:1 ratio. For convenience in observing the results, 1 ml of secondary additive and 1 ml of i.v. admixture were drawn in sterile disposable syringes under aseptic conditions and mixed in a clean test tube. Visual (macroscopic) and microscopic observations were performed on each mixture immediately after preparation and four hours later. The i.v. fluids used were dextrose 5% in water, sodium chloride 0.9%, and lactated Ringer's solution. The primary additives were: (1) vitamin B complex with C, (2) potassium chloride, and (3) heparin sodium and hydrocortisone sodium succinate. The secondary additives tested (in usual clinical concentrations) were: aminophylline, ampicillin sodium (four concentrations), calcium gluconate, cephalothin sodium, dexamethasone sodium phosphate, diazepam, digitoxin, digoxin, conjugated estrogens, ethacrynate sodium, insulin, kanamycin sulfate, lidocaine hydrochloride, methylprednisolone sodium succinate, phenytoin sodium, penicillin G potassium, prednisolone sodium phosphate, sodium bicarbonate, succinylcholine chloride, and sterile water for injection. Most of the drugs studied were found to be physically compatible. Incompatibilities of secondary additives observed included phenytoin sodium, diazepam and methylprednisolone sodium succinate. Some of the factors a pharmacist should be concerned with in additives at Y-infection sites are pH, solubility and the specific formulations of the additives. It is suggested that the pharmacist should monitor the addition of any drug at a Y-injection site of an i.v. admixture administration set.
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Allen et al. (1977) studied this question.