Compatibility of Lactated Ringer’s Injection With 94 Selected Intravenous Drugs During Simulated Y-site Administration

Abstract

Objective: To test the compatibility of intravenous (IV) lactated Ringer’s injection (LR) with 94 injectable (IV) drugs during simulated Y-site administration. Methods: Ninety-four IV drugs were investigated for compatibility with LR (Baxter). Each sample was prepared in duplicate and performed at room temperature. Two observers performed visual evaluation independently immediately upon mixing and then 15 minutes, 1 hour, 2 hours, 3 hours, and 4 hours after admixture. Another observer performed a particle counting test on 1 of the 2 duplicates of each admixture that did not immediately show incompatibility and then after 4 hours by a light obscuration particle count test. Results: Of the 94 tested drugs, 86 were found to be compatible with LR. A total of 8 drugs were found to be physically incompatible. Of these incompatible drugs, 7 were directly identified visually and 1 was confirmed by the light obscuration particle count test. Conclusion: Lactated Ringer’s injection was physically compatible for 4 hours with 86 tested drugs during simulated Y-site administration. Eight drugs, ciprofloxacin, cyclosporine, diazepam, ketamine, lorazepam, nitroglycerin, phenytoin, and propofol, were found to be incompatible and should not be administered with LR.

Trauma: The most progressive subspecialty of all

“…Its safety is unquestioned, though drug incompatibilities exist (ciprofloxacin, diazepam, ketamine, lorazepam, nitroglycerin, phenytoin, and propofol). 15 So, modern resuscitation with crystalloids is still mainly with a solution developed by Sydney Ringer 140 years ago and modified by Alexis Hartmann, MD, 90 years ago. The use of Ringer's lactate has obviously decreased in recent years.…”

“…When compared with normal saline, the other crystalloid solution used for resuscitation, Ringer's lactate is hypotonic, less acidic (pH 6.5 vs. pH 5.5), and contains K + , Ca ++ , and lactate. Its safety is unquestioned, though drug incompatibilities exist (ciprofloxacin, diazepam, ketamine, lorazepam, nitroglycerin, phenytoin, and propofol) 15 …”

Crystalloid and Colloid Compositions and Their Impact

“…Balanced isotonic crystalloids can be co-administered with many medications, but some important drug incompatibilities have been identified. For example, Plasma-Lyte 148 is incompatible with pantoprazole, cyclosporine, and midazolam while LRS is incompatible with diazepam, ketamine, and cyclosporine ( 63 , 85 ).…”

Physical and Chemical Compatibility of Medications Commonly Used in Critically Ill Patients With Balanced Crystalloids: A Systematic Review

“…A total of 2961 publications via search of databases and 35 publications from additional sources were assessed, and 35 manuscripts were identified for inclusion (Figure 1). Six studies were adjudicated as high risk of bias 20-25 and excluded from further analysis, for a final inclusion of 29 studies 26-54 (Supplementary Figures 1 and 2). Full characteristics of all included studies can be found in Supplementary Table 3.…”

“…Some of the medications included in this review have only one unique assessment evaluated, which significantly limits generalizability. 46,48,50 Other medications were assessed in multiple different combinations but by only one study, which again limits external validity. 33,39,48 Recently the importance of utilizing balanced crystalloids instead of normal saline for resuscitation in critically ill patients has been emphasized to decrease the risk of hyperchloremic AKI, metabolic acidosis, and potentially mortality.…”