In(compatibility) of intravenous drugs in critical units: adult cohort

historic cohort (retrospective) with 110 adults in critical units. Intravenous medications were identified concomitantly, whose pairs were analyzed for (in) compatibility using the screening system Trissel’s™ 2 Compatibility IV-Micromedex 2.0. Parametric and non-parametric statistic were used according to the nature of the variable.

Results:

565 pairs of drugs were identified. Of these, 44.9% were compatible; and 8.8%, potentially incompatible. Most potentially incompatible pairs involved substances with alkaline pH such as phenytoin (32%) and sodium bicarbonate (8%) and weak acids such as midazolam (12%) and dobutamine (6%), which could result in precipitate formation.

Conclusions:

almost half of the mixtures simultaneously administrated was compatible, which indirectly reflects in the organized work between the nursing team and the clinical pharmaceutic in the discussions and decisions related to time scheduling.

Descriptors:
Intravenous Administration; Incompatibility of Drugs; Intensive Care Units; Critical Care Nursing; Nursing Education

Demographic, clinical and progress variables	N = 110
Demographic, clinical and progress variables	n (%)	Average (± SD)
Gender Masculine Feminine	58 (52.7) 52 (47.3)
Age		62.9 (16.3)
Number of comorbidities		2.3 (±1.8)
Origin First-aid Post ICU, SICU and Operating room Infirmary	48 (43.6) 48 (43.6) 14 (12.8)
Place of hospitalization ICU SICU	85 (77.3) 25 (22.7)
Type of hospitalization Clinic Surgical	67 (61.0) 43 (39.0)
Length of stay		7.2 (±4.7)
SAPSII		48.6 (±24.9)
Discharge condition Survivor Not survivor	94 (85.4) 16 (14.6)

Variables related to therapeutic and progress regime	Admission		Discharge		p value
Variables related to therapeutic and progress regime	n (%)	Average (± DP )	n (%)	Average (± DP)	p value
Number of prescribed drugs		6.1 (±2.5)		3.5 (±2.4)	≤ 0.001^* * Paired T-teste;
Number of prescribers		1.7 (±0.8)		1.2 (±0.5)	≤ 0.001^ Wilcoxon test;
Vascular devices		1.9 (±0.7)		1.3 (±0.5)	≤ 0.001^ Wilcoxon test;
Drugs continuously infused	66 (60%)		21 (19%)		≤ 0.001 ^* ***** McNemar test.
Drugs intermittently infused	110 (100%)		98 (89%)		= 0.001 ^* ***** McNemar test.
NAS		56.1 (±14.5)		47.5 (±11.4)	≤ 0.001^* * Paired T-teste;

Potentially incompatible drug pairs (pH)	Potential physic-chemical alterations	Patients with double prescription n (%)
Midazolam (pH 3.0) × Omeprazole sodium (pH 8.0-10.0)	Change in color and precipitate formation	11 (23.9%)
Sodium bicarbonate (pH 7.0-8.5) × Norepinephrine (pH 3.0-4.5)	Chemical decomposition	6 (13%)
Dobutamine (pH 2.5-5.5) × Ceftriaxone sodium (pH 5.0-8.5)	Particle formation and/or change in color	5 (10.8%)
Clindamycin (pH 5.5-7.0) × Ceftriaxone sodium (pH 5.0-8.5)	Chemical decomposition	5 (10.8%)
Imipenem + cisplatin (pH 6.5-8.5) × Amiodarone (pH 4.0)	Change in color	4 (8.7%)
Haloperidol (pH 3.0-3.8) × Ceftriaxone sodium (pH 5.0-8.5)	Particle formation and/or change in color	4 (8.7%)
Phenytoin (pH 12.0) × Fentanyl (pH 4.0-7. 5)	Precipitate formation	3 (6.5%)
Dobutamine (pH 2.5-5.5) × Hydrocortisone (pH 7.0-8.0)	Particle formation and/or change in color	3 (6.5%)
Midazolam (pH 3.0) × Sodium bicarbonate (pH 7.0-8.5)	Particle formation and/or change in color	3 (6.5%)
Furosemide (pH 8.0-9.3) × Ondansetron (pH 3.0-4.0)	Particle formation and/or change in color	3 (6.5%)
Sodium bicarbonate (pH 7.0-8.5) × Amiodarone (pH 4.0)	Turbidity after one hour and precipitate formation	2 (4.3%)
Dobutamine (pH 2.5-5.5) × Piperacillin + Tazobactam (pH 1.8-3.0)	Turbidity	2 (4.3%)
Piperacillin + Tazobactam (pH1.8-3.0) × Insulin (pH 7.0-7.8)	Fog and particle formation	2 (4.3%)
Metoclopramide (pH 4.5-6.5) × Cefepime (pH 4.0-6.0)	Turbidity	2 (4.3%)
Phenytoin (pH 12.0) × Furosemide (pH 8.0-9.3)	Precipitate formation	2 (4.3%)

Associação Brasileira de Enfermagem SGA Norte Quadra 603 Conj. "B" - Av. L2 Norte 70830-102 Brasília, DF, Brasil, Tel.: (55 61) 3226-0653, Fax: (55 61) 3225-4473 - Brasília - DF - Brazil
E-mail: reben@abennacional.org.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Corresponding author: Julia Helena Garcia. E-mail: jhgmogi@yahoo.com.br