Caffeine citrate, clindamycin, enalaprilat, epinephrine, fluconazole, fosphenytoin sodium, hydrocortisone, metoclopramide, and midazolam exhibited no visual or turbidimetric evidence of incompatibility when combined with a neonatal TPN solution for up to three hours in a simulated Y-site injection. Amiodarone, pentobarbital, phenobarbital, and rifampin were not compatible with the neonatal TPN solution and should not be coadministered via Y-site injection.

Abstract Purpose Critically ill patients with septic shock often receive multiple intravenous medications, necessitating either the placement of separate lines for medication administration or administration of medications concurrently through a Y-site connector only where compatibility has been demonstrated. The purpose of this study was to examine the physical compatibility of hydrocortisone infusions and select intravenous medications through a simulated Y site. Methods The medications tested for simulated Y-site physical compatibility with hydrocortisone included acetaminophen, albumin, cefepime, ciprofloxacin, cisatracurium, doripenem, epinephrine, esomeprazole, ibuprofen, levofloxacin, levothyroxine, meropenem, and norepinephrine. Hydrocortisone in solution with 0.9% sodium chloride injection was combined with an equivalent volume of solutions of each test drug at maximum or commercially available concentrations used clinically in intensive care units, as appropriate. The samples were evaluated using turbidimetric measurements and examined visually against light and dark backgrounds to determine physical compatibility. Observations and analyses were completed over a one-hour period at 15-minute intervals beginning immediately after mixing. Each test was performed in triplicate. Results All study medications demonstrated visual and/or turbidimetric physical compatibility when combined with hydrocortisone in a simulated Y-site infusion. No medications demonstrated a visual physical incompatibility when combined with hydrocortisone. Conclusion Acetaminophen, albumin, cefepime, ciprofloxacin, cisatracurium, doripenem, epinephrine, esomeprazole, ibuprofen, levofloxacin, levothyroxine, meropenem, and norepinephrine exhibited physical compatibility with hydrocortisone via Y-site infusion.

Background: Viral induced hemorrhagic cystitis (VIHC) is very common among patients who become immunocompromised following organ transplantation. However, there is neither consensus on the standard of care nor clear guidelines to aid in clinical decision making when treatment VIHC. This review discusses currently available pharmacologic agents, presents investigational drug therapies, and outlines alternative treatment options that could be effective against VIHC.Recent findings: Letermovir is a novel antiviral agent approved for CMV prophylaxis in patients post-hematopoietic stem cell transplantation (HSCT). Although no studies have yet been conducted in patients with VIHC, this new antiviral agent shows promise in preventing emergence of CMV in patients after HSCT. Additionally, newer studies addressing the efficacy of brincidofovir, an experimental drug derived from cidofovir, against CMV infection may provide preliminary evidence for brincidofovir’s role in therapy and therefore warrant further investigation.Conclusion: Polyoma BK virus (BKV), cytomegalovirus (CMV), and adenovirus (ADV) are the primary culprits for HC occurrence in patients undergoing renal transplantation or allogeneic HSCT. CMV-associated HC could be prevented or treated by ganciclovir and valganciclovir because these agents’ effectiveness has been clearly established in other non-HC infections related to CMV. ADV-associated HC could be mitigated by brincidofovir and ribavirin, however the high toxicity associated with these agents may be a limiting factor for their use. BKV-associated HC is best managed by cidofovir and leflunomide, but not by fluoroquinolones. Finally, intravesicular instillation should be preferred in patients who experience toxicities associated with systemic use of antivirals.