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Drug incompatibilities in intravenous therapy: evaluation and proposition of preventive tools in intensive care and hematology units

  • Pharmacodynamics
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Abstract

Purpose

Physicochemical incompatibility (PCI) between drugs infused together is frequent, but under-recognized. PCI can lead to drug inactivity, catheter occlusion, embolism or inflammatory reactions. The aims of this work were to identify most frequent and relevant drug incompatibilities and to review and develop strategies for their prevention.

Method

This was an observational prospective survey conducted between January and March 2015 in an intensive care unit (ICU) and in September 2014 in a hematology sterile unit (HSU). Drugs administered to patients were recorded and their compatibility assessed based on published compatibility data.

Results

Drug incompatibilities accounted for 12% (23/189) and 17% (116/686) of drug pairs infused in the ICU and the HSU, respectively. Pantoprazole was the most frequent drug implied in PCI. Regarding drug classes, anti-infective agents and gastrointestinal drugs were the most frequently implied. Among the incompatible pairs, 78% and 61% implicated a drug with extreme pH in the ICU and HSU, respectively. The tools proposed to reduce the frequency of PCI included: compatibility cross-tables, labeling of drugs with extreme pH and optimized administration schedules.

Conclusions

Given the frequency and the potential for severe consequences of PCI, pharmacists have a role to play in raising awareness of nurses and practitioners, and proposing adequate tools and solutions to reduce their incidence.

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Acknowledgments

Marion Nouvel, Anne-Gaëlle Caffin, Géraldine Iroir, Bérengère Clerc, Carole Dugrenier, Corinne Béal, Gilles Salles, Catherine Rioufol.

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Authors and Affiliations

  1. Department of Pharmacy, Groupement Hospitalier Sud, Hospices Civils de Lyon, 165 Chemin du Grand Revoyet, 69495, Pierre Bénite, France

    Ophélie Maison, Cléa Tardy, Delphine Cabelguenne, Stéphanie Parat & Laure Lalande

  2. Department of Hematology Oncology, Groupement Hospitalier Sud, Hospices Civils de Lyon, 165 Chemin du Grand Revoyet, 69495, Pierre Bénite, France

    Sophie Ducastelle

  3. Department of Critical Care, Groupement Hospitalier Sud, Hospices Civils de Lyon, 165 Chemin du Grand Revoyet, 69495, Pierre Bénite, France

    Vincent Piriou & Alain Lepape

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  1. Ophélie Maison
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Correspondence to Ophélie Maison.

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Maison, O., Tardy, C., Cabelguenne, D. et al. Drug incompatibilities in intravenous therapy: evaluation and proposition of preventive tools in intensive care and hematology units. Eur J Clin Pharmacol 75, 179–187 (2019). https://doi.org/10.1007/s00228-018-2602-6

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  • DOI: https://doi.org/10.1007/s00228-018-2602-6

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