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. 2007 Jan-Mar;12(1):53–59. doi: 10.5863/1551-6776-12.1.53

Y-Site Compatibility of Medications with Parenteral Nutrition

Christine A Robinson 1,✉, Jaclyn E Lee 1
PMCID: PMC3462161  PMID: 23055843

Abstract

Providing parenteral nutrition to pediatric patients requiring various other intravenous products can be challenging. Evaluation of compatibility is essential; however, information is limited and sometimes conflicting. We strove to critically evaluate and present the available published data as a comprehensive and practical reference. To accomplish this, we weighed the strength of evidence supporting compatibility versus incompatibility and provided specific conditions affecting compatibility, where appropriate. Many commonly used medications in pediatric patients have consistently demonstrated Y-site compatibility with parenteral nutrition and may be safely administered simultaneously. Exceptions must be noted and these medications should preferentially be administered through a separate line, if available, or the same line may be used only after stopping the parenteral nutrition infusion and flushing the line before and after drug administration.

Keywords: medication, compatibility, parenteral nutrition, y-site

Many pediatric conditions such as abdominal wall defects of the newborn and short bowel syndrome warrant the use of parenteral nutrition. Obtaining and maintaining venous access in pediatric patients complicates the administration of this form of nutrition. Many patients require multiple treatment modalities to be administered intravenously including, medications, fluids, blood products and nutrition. Clinicians must optimize available access to ensure appropriate and timely administration of all products prior to establishing additional access. This may require simultaneous administration of medications and parenteral nutrition, therefore compatibility considerations become essential. It is important to recognize that compatibility only reflects the physical interactions such as formation of a precipitate and does not necessarily address stability or pharmacologic activity of the products. Published data may report both compatibility and stability, however most evaluate compatibility alone. Currently there are multiple resources to use when answering the question of compatibility with parenteral nutrition. We strove to evaluate and present the available published data as a comprehensive and practical reference. We sought out primary literature regarding y-site compatibility of multiple drugs commonly used in pediatric patients with three different parenteral nutrition formulas, 3-in-1, 2-in-1 and lipids alone. When conflicting results were encountered the clinical strength was considered. When published data were not accessible Trissel's Handbook on Injectable Drugs1 was used. Below please find each of the classifications utilized in this reference:

C

Compatibility has been demonstrated. When Y-site compatibility was not available, medications compatible in-solution for 24 hours were assumed to be Y-site compatible. Medications compatible with 3-in-1 admixtures were assumed to be compatible with lipids alone.1

I

Incompatibility has been demonstrated

—

Compatibility data not available

C/I

Conflicting compatibility has been demonstrated and strength of the evidence supports compatible

I/C

Conflicting compatibility has been demonstrated and strength of the evidence supports incompatible

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Footnotes

DISCLOSURE The authors declare no conflicts or financial interest in any product or service mentioned in the manuscript, including grants, equipment, medications, employment, gifts, and honoraria.

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