Maxime Perez1, Bertrand Décaudin2, Aurélie Foinard3, Christine Barthélémy3, Bertrand Debaene4, Gilles Lebuffe5, Pascal Odou1. 1. Department of Biopharmacy, Galenic and Hospital Pharmacy, Lille 2 University, UDSL, EA GRITA, UFR Pharmacie, 59037 Lille, France; Department of Pharmacy, CHRU Lille, 59037 Lille, France. 2. Department of Biopharmacy, Galenic and Hospital Pharmacy, Lille 2 University, UDSL, EA GRITA, UFR Pharmacie, 59037 Lille, France; Department of Pharmacy, CHRU Lille, 59037 Lille, France. Electronic address: bertrand.decaudin@univ-lille2.fr. 3. Department of Biopharmacy, Galenic and Hospital Pharmacy, Lille 2 University, UDSL, EA GRITA, UFR Pharmacie, 59037 Lille, France. 4. Department of Anesthesia and Intensive Care, Poitiers University Hospital, Inserm U1070, 86021 Poitiers, France. 5. Department of Anesthesia and Intensive Care Medicine, Lille University Hospital, EA 1046, IFR 114, 59037 Lille, France.
Abstract
OBJECTIVE: Drug incompatibilities can jeopardize the safety and effectiveness of intravenous drug therapies, especially in the field of anaesthesia and intensive care. Patients receive many drugs simultaneously through limited venous accesses. This study was designed to confirm the impact of a multilumen infusion device on the occurrence of known physical drug incompatibilities. STUDY DESIGN: In vitro laboratory work. METHODS: Two infusion devices were studied: a standard single-lumen set and a multilumen infusion access device (Edelvaiss Multiline-8, Doran International). Up to six drugs were infused simultaneously: three acidic solutions of midazolam, amiodarone and dobutamine, and three alkaline solutions of furosemide, pantoprazole and amoxicillin/clavulanate. Saline, Ringer' solution and 5% dextrose were used as hydration vehicles with an infusion rate initially set at 100 mL/h and with stepwise decreases of 10 mL/h until precipitation. Two methods were used to highlight physical drug compatibility according to the European Pharmacopoeia: visual inspection of the extension set and an obscured-light sub-visible particle count test of infusions. The lowest infusion rate value for vehicle infusion to satisfy the two tests in all trials is reported for each infusion device. RESULTS: The standard set did not satisfy the test in 82% of the assessed drug combinations. The Edelvaiss Multiline-8 was able to prevent the occurrence of drug incompatibilities in 49% of the drug combinations tested. This device is therefore advantageous, especially when simultaneously infusing two or four incompatible drugs. CONCLUSIONS: Infusion device characteristics have an impact on physical drug incompatibilities. Our results confirm that the Edelvaiss Multiline-8 device prevents physical drug incompatibilities under specified conditions.
OBJECTIVE: Drug incompatibilities can jeopardize the safety and effectiveness of intravenous drug therapies, especially in the field of anaesthesia and intensive care. Patients receive many drugs simultaneously through limited venous accesses. This study was designed to confirm the impact of a multilumen infusion device on the occurrence of known physical drug incompatibilities. STUDY DESIGN: In vitro laboratory work. METHODS: Two infusion devices were studied: a standard single-lumen set and a multilumen infusion access device (Edelvaiss Multiline-8, Doran International). Up to six drugs were infused simultaneously: three acidic solutions of midazolam, amiodarone and dobutamine, and three alkaline solutions of furosemide, pantoprazole and amoxicillin/clavulanate. Saline, Ringer' solution and 5% dextrose were used as hydration vehicles with an infusion rate initially set at 100 mL/h and with stepwise decreases of 10 mL/h until precipitation. Two methods were used to highlight physical drug compatibility according to the European Pharmacopoeia: visual inspection of the extension set and an obscured-light sub-visible particle count test of infusions. The lowest infusion rate value for vehicle infusion to satisfy the two tests in all trials is reported for each infusion device. RESULTS: The standard set did not satisfy the test in 82% of the assessed drug combinations. The Edelvaiss Multiline-8 was able to prevent the occurrence of drug incompatibilities in 49% of the drug combinations tested. This device is therefore advantageous, especially when simultaneously infusing two or four incompatible drugs. CONCLUSIONS: Infusion device characteristics have an impact on physical drug incompatibilities. Our results confirm that the Edelvaiss Multiline-8 device prevents physical drug incompatibilities under specified conditions.