Compatibility of prolonged infusion antibiotics during Y‐site administration

Abstract

Background: Antimicrobial resistance is a threat to global public health. The use of prolonged infusions in the hospital setting for certain antimicrobials is widely increasing in order to improve their efficacy and safety, including resistance development.Due to limited vascular access, it is important to clarify whether they can be infused through the same line with other drugs during Y-site administration.Aim: The aim of this review is to update and summarize the evidence on Y-site compatibility of antibacterial agents administered as prolonged infusions in intensive care units (ICUs).Study Design: A literature review of PubMed, EMBASE and Trissel's Handbook on Injectable Drugs databases was conducted on the compatibility of selected antimicrobials administered simultaneously at a Y-site connection with parenteral nutrition and other widely used drugs in ICUs. All articles published up to October 30, 2021, in English or Spanish were included, regardless of the type of publication (original articles, case reports, letters, etc.). Eligible antimicrobials were those that can be administered as prolonged infusions: ceftazidime, cefepime, piperacillin/tazobactam, meropenem, ceftolozane/tazobactam, ceftaroline, cloxacillin, ceftobiprole, vancomycin and fosfomycin.Results: A total of 1302 drug-to-drug potential combinations were explored, 196 (15.05%) were found to be incompatible, and in 541 (41.55%), data were not available. The results were presented in a simple 2-dimensional consultation chart as a quick reference for health care professionals.Conclusions: This review provides useful and reliable information on the compatibility of antimicrobials administered as Y-site infusion with other drugs commonly used in the critical setting. This review contributes to patient safety in nursing practice.Relevance to Clinical Practice: To our knowledge, this is the first review on Y-site compatibility of antimicrobials used as prolonged infusions with other commonly used drugs, including anti-emetics, analgesics and anti-epileptic and parenteral nutrition. The results of the current review need to be addressed to promote the knowledge sharing between health professionals and improve the quality and safety of

Systematic Review of Piperacillin-Tazobactam and Vancomycin Y-Site Compatibility: Consideration of Concentration and Solution Variability

“…One review article was identified through this search; however, it only offered a simplified compatibility chart for 10 antibiotics and 131 commonly used medications. 9 None of the articles included in this assessment are meta-analyses. An additional search was performed utilizing multiple tertiary databases to determine available compatibility information.…”

Critical Commentary on the paper: Compatibility of prolonged infusion antibiotics during Y‐site administration with parenteral nutrition

“…More recently, in 2022, Nunez‐Nunez et al reviewed the Y‐site compatibility between antibiotics in prolonged infusion with drugs commonly administered in ICUs. They analysed a total of 1302 drug‐to‐drug potential combinations and presented them in simple 2‐dimensional consultation chart 9 . Despite the extensive summary of evidence carried out, there are some recommendations related to drugs and PN Y‐site compatibility that could pose a risk to patients and should be considered with caution.…”

“…Finally, we consider it advisable to divide the compatibility recommendations based on the PN admixture types (3‐in‐1 or 2‐in‐1). After reviewing this paper 9 and the other references, we propose the following guide (Table 1) in administering selected antibiotics with PN.…”

“…They analysed a total of 1302 drug-to-drug potential combinations and presented them in simple 2-dimensional consultation chart. 9 Despite the extensive summary of evidence carried out, there are some recommendations related to drugs and PN Y-site compatibility that could pose a risk to patients and should be considered with caution.…”

Spotlight on literature reviews

“…This issue features six reviews that showcase some different review types: two systematic reviews with a meta‐analysis 4,5 ; two systematic reviews without a meta‐analysis 6,7 and two scoping reviews 8,9 . These investigate the prevalence of depressive symptoms among intensive care nurses and the effect of enteral immunomodulatory nutrition formula on the outcomes of critically ill patients; targeted temperature management in acute liver failure and the compatibility of prolonged antibiotic infusion administration; and the use of virtual reality in intensive care units and educational interventions to reduce the use of physical restraints, respectively.…”