Strategies to prevent drug incompatibility during simultaneous multi-drug infusion in intensive care units: a literature review

PURPOSE

Drug protocols in intensive care units may require the concomitant administration of many drugs as patients' venous accesses are often limited. A major challenge for clinicians is to limit the risk of simultaneously infusing incompatible drugs. Incompatibilities can lead to the formation of particles and inactivation of drugs, whose consequences on the body have already been indicated. Our objective was to assess current strategies to counter the risk of incompatible infusions and control the resulting clinical consequences.

METHODS

This review was independently conducted by three investigators in respect of the PRISMA statement. Three online databases were consulted. Full-text articles, notes, or letters written in English or French, published or in press between the 1990s and the end of February 2020, with clinical study design, were eligible. Parameters of interest were mainly number and size of particles, and a number of observed/avoided incompatibilities.

RESULTS

All in all, 382 articles were screened, 17 meeting all the acceptance criteria. The strategies outlined and assessed were filtration, the use of multi-lumen devices, the purging of infusion lines, incompatibility tables and databases, and the use of standard operating procedures.

CONCLUSION

Although many strategies have been developed in recent years to address drug incompatibility risks, clinical data is still lacking. All studies with in vitro design were excluded although some current innovative strategies, like niosomes, should be considered and studied by means of clinical data in the future.

Pharmaceutical Technology in Practice: A Personal View

This opinion piece argues that the collective knowledge of drugs and medicines, their nature, formulation and manufacture, their delivery and evaluation is unique to pharmacy and it reasserts the fact that science underpins the clinical use of medicines. It argues this from a personal standpoint of an academic pharmaceutical technologist and recounts examples from the author’s own experience.