Physical compatibility of various drugs with neonatal total parenteral nutrient solution during simulated Y-site administration

Abstract

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.

Physical compatibility of total parenteral nutrition and drugs in Y-site administration to children from neonates to adolescents

“…As also increased turbidity and Tyndall effect were observed for clindamycin alone (Table ), it is likely that these findings could be ascribed to the drug itself rather than incompatibility with TPN. This is supported by Fox et al . who also found clindamycin to be compatible with a neonatal TPN admixture, as well as other reports on this drug …”

“…No signs of precipitation were observed with Numeta. The pH values of these drugs were close to that of TPN, and the drugs have also been reported to be compatible with TPN in other studies …”

“…There is a lack of compatibility data for drugs administered to paediatric patients . Parenteral nutrition admixtures given to children often differ from those given to adults, both in composition and pH (usually more acidic) . Lower amino acid concentration and higher concentration of calcium and phosphate in paediatric admixtures increase the risk of calcium phosphate precipitation .…”

“…Different dosages, drug concentrations, total parenteral nutrition (TPN) composition and infusion times might lead to different mixing ratios in the line compared with those used in adults. Extrapolation of compatibility data based on conditions applicable for adults is not recommended . In fact, extrapolation of compatibility data is not recommended in general, at least not without careful consideration, due to the complexity and wide ranges of TPN compositions.…”

Overview of Home Parenteral Nutrition: An Update

“…Metoclopramide is a prokinetic gastrointestinal agent commonly used for chronic nausea. If chronic IV use is necessary, it can be administered with PN via Y‐site administration 50 . The stability has been studied most extensively in neonates.…”