US EPA

4119556 

Journal Article 

Compatibility of drugs separated by a fluid barrier in a retrograde intravenous infusion system 

Garner, SS; Wiest, DB 

1990 

Yes 

American Journal of Hospital Pharmacy
ISSN: 0002-9289 

IPA/90/906271 

J 

REF 7 

604-606 

English 

2107740 

IPA COPYRIGHT: ASHP The use of 2 ml of 5% dextrose or 0.9% sodium chloride injections as a fluid barrier to prevent the mixing of sequentially administered drug pairs known to exhibit visual incompatibility was studied at various flow rates in a retrograde infusion system assembled to simulate the intravenous administration of a drug to a 2 kg neonate; 4 pairs, calcium gluconate (I) with sodium bicarbonate or sodium phosphate (sodium phosphate dibasic) and gentamicin (II) with phenytoin or furosemide, were tested. The fluid barrier consisted of 2 ml of 5% dextrose for all pairs, except II-phenytoin. If no precipitation occurred in the system at a 20 ml/h flow rate, the drug pairs were tested at 10 and 5 ml/h flow rates. Precipitation of 3 of the 4 drug pairs was evident at the 20 ml/h flow rate. Ineffectiveness of the fluid barrier was evident with the I-sodium phosphate pair (precipitation in stopcock and catheter) and the II and furosemide or phenytoin pairs (precipitation in stopcock and tubing). The I-sodium bicarbonate pair did not precipitate, perhaps because of the calcium salt used. In a retrograde infusion system, a 2 ml fluid barrier of 5% dextrose injection injected between pairs of incompatible drug solutions did not remove the first drug solution from the stopcock adequately to prevent its interaction with the second solution. Drug dilution before administration or the lack of subsequent administration of physically incompatible drugs may explain the lack of visible precipitation in clinical situations.