Compatibility of selected drugs with pediatric parenteral nutrition solutions

The compatibility of 26 drugs with two different pediatric parenteral nutrition (PN) admixtures (one peripheral and one central- line formula) during simulated Y-site administration was studied. PN admixtures contained, beside glucose, electrolytes and trace elements, two different amino acid solutions (Vaminolact or Aminovenös N Pëd, Fresenius Kabi). Each of the two PN admixtures was combined in a 1:1 ratio with samples of solutions of 26 drugs undiluted or diluted in 0.9% sodium chloride injection, 5% glucose injection or water for injection. Visual examinations were performed under fluorescent laboratory light and under halogen light at intervals of up to 4 hours after mixing. During simulated Y-site administration, six drugs were found incompatible with one of or both PN admixtures - aminophylline, ceftriaxone, dexamethasone, midazolam, sodium bicarbonate and ranitidine. In extrapolating the results of this study to clinical practice, care must be taken that the PN admixtures and drug solutions closely resemble those used in this study. Further studies are needed to confirm the chemical stability and compatibility of drugs and PN admixtures as well.