Compatibilities for IV Y-site Administration

 

Prepared by Brenda Hughes
Clinical Pharmacist,
Dept. Of Pharmacy, Auckland Healthcare
May 1999
Newborn Drug Protocol Index Back Newborn Services Home Page
Compatible (at Y-site only) X  Incompatible ?  Unknown

Numbers below refer to references.  Symbols are explained immediately below the table.

  Aminophylline
pH 8.8-10.0		 Caffeine
pH 2.0-3.0		 Dobutamine
pH 2.5-5.5		 Dopamine
pH 2.5-4.5		 Fentanyl
pH 4.0-7.55		 Heparin
pH 5.5-8.0		 Indomethacin
pH 6.0-7.5		 Morphine
pH 2.5-6.0		 Prostaglandin E1 NaHCO3
pH 7.0-8.5		 IVN
pH 5.5-6.5		 Intralipid
pH 5.5
Aminophylline
pH 8.8-10.0		   ? X
1
1		 ?
+++ 1		 ?
12
++ 10 +		 ? X
21		 X
13
Caffeine
pH 2.0-3.0		 ?   ? ? ? ? X
2		 ? ? ? X
4		 X
Dobutamine
pH 2.5-5.5		 X
1		 ?  
1		 ? ?
***		 X
11
5		 ? X
1
20		 ?
Dopamine
pH 2.5-4.5
1		 ?
1		   ?
1		 X
11
1
+ 10		 X
1, 3
20		 ?
Fentanyl
pH 4.0-7.55		 ? ? ? ?  
1		 ? ? ? ?
20		 ?
Heparin
pH 5.5-8.0
+++ 1		 ? ?
1
1		   ?
* 6
+ 10		 ? ?
# 1
Indomethacin
pH 6.0-7.5		 ? X
2		 X
11		 X
11		 ? ?   X
8, 9		 ? X
11		 X
11		 X
8, 9
Morphine
pH 2.5-6.0
12		 ?
5
1		 ?
* 6		 X
8, 9		  
+ 10
1, 18
20		 ?
**15
Prostaglandin E1
++ 10 +		 ? ?
+ 10		 ?
+ 10		 ?
+ 10		   ? ? X
7
NaHCO3
pH 7.0-8.5		 ? ? X
1		 X
1, 3		 ? ? X
11
1, 18		 ?   ? X
IVN
pH 5.5-6.5		 X
21		 X
4
20
20
20		 ? X
11
20		 ? ?   ?
Intralipid
pH 5.5		 X
13		 X
 ? ? ?
#1		 X
8, 9		 ?
** 15		 X
7		 X
 ?  

IVN  = Intravenous  Nutrition
+ =  these drugs have a negligible effect on alprostadil (PGE 1), but the reverse not studied.
++ = in sodium chloride 0.9%
+++ = in glucose 5%
* = morphine ≤5mg/ml
** No conclusive data
 *** conflicting results in studies (16, 19)
# destabilisation of fat emulsion has been noted at heparin 5 iU/ml (14) & 0.5 iU./ml (17) when co-infused with TPN containing Ca++

Concentrations of Drugs used in NICU

Drug

Concentration Used in NICU

Aminophylline

5mg per mL

Caffeine base

10mg per ml (Caffeine citrate 20mg per mL)

Dobutamine

0.05 to 3.5 mg per mL

Dopamine

0.05 to 3.5 mg per mL

Fentanyl

1.0 to 15.0 mcg per mL

Heparin

0.5 to 2.0 units per mL

Indomethacin

0.5 to 1.0 mg per mL

Morphine

0.01 to 2.0 mg per mL

Prostaglandin (PGE1)

3.0 to 6.0 mcg per mL

Sodium bicarbonate

0.5 mmol per mL

Parenteral Nutrition

  

Intralipid

20%

References

1 Trissel LA, (ed). Handbook on Injectable Drugs (7th ed.). Bethesda: American Society of Hospital Pharmacists,1992.
2 Indocid P.D.A. Data Sheet. Auckland: Merck Sharp & Dohme (NZ) Ltd., 1997.
3 Dopamine data sheet. Victoria: F.H.Faulding & Co.Ltd,1992.
4 Roiall V. (Personal Correspondence). McGaw Biomed, August 1997.
5 Hasegawa G, Eder J. Visual compatibility of dobutamine HCl with other injectable drugs. Am J Hosp Pharm 1984;41: 949-51.
6 Baker DE,Yost GS et al. Compatibility of heparin sodium & morphine sulphate. Am J Hosp Pharm 1985;42:1352-5.
7 Little H. (Personal correspondence). Baxter Healthcare Ltd. 17 July 1996.
8 Indomethacin data sheet. West Point: Merck&Co.Inc,1994.
9 Reynolds JF, (ed). Martindale - The Extra Pharmacopoeia(30th ed). London: The Pharmaceutical Press,1993 .
10 Saunders J. (Personal correspondence) .Pharmacia & Upjohn.Aug.1996
11 Ishisaka D, Van Vleet J, et al. Visual compatibility of indomethacin sodium trihydrate with drugs given to neonates by continuous infusion. Am J Hosp Pharm 1991; 48: 2442-3
12 Dasta JF, Hale KN et al. Comparison of visual and turbidimetric methods for determining short-term compatibility of intravenous critical -care drugs. Am J Hosp Pharm.1988; 45:2361-6.
13 Gillies IR. Physical stability of Intralipid following drug addition. Aust J Hosp Pharm 1980; 10(3):118-120.
14 Johnson O, Washington C, et al. The destabilization of parenteral feeding emulsions by heparin. Int. J of Pharmaceutics. 1989;53: 237-240.
15 Little H. (Personal correspondence). Baxter Healthcare Ltd. June 1996.
16 Schilling CG. (Correspondence). Compatibility of drugs with a heparin-containing neonatal total parenteral nutrient solution. Am J Hosp Pharm 1988; 45:313-4
17 Raup P, Von Kries R. et al. Incompatibility between fat emulsion and calcium plus heparin in parenteral nutrition of premature babies. Lancet 1988; 1:700.
18 Zenk KE. Y-Site compatibility of drugs commonly used in the NICU. Neonatal Pharmacology Quarterly 1992; 1(2): 13-22.
19 Hasegawa GR, Eder JF. Dobutamine-heparin mixture inadvisable. Am J Hosp Pharm 1984; 41:2590-1.
20 Veltri M, Lee C. Compatibility of neonatal parenteral nutrient solutions with selected intravenous drugs. Am J Health-Syst Pharm 1996; 53:2611-3.