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KARIN NEMEC, D.Sc., is Clinical Pharmacist, Department of Hospital Pharmacy, Donauspital, Vienna, Austria. HANNELORE KOPELENT-FRANK, D.Sc., is Assistant Professor, Department of Medical Chemistry, Faculty of Life Sciences, University of Vienna, Vienna; and ROBERT GREIF, M.D., M.M.E., UNIBE, is Associate Professor of Anesthesiology and Intensive Care Medicine, Department of Anesthesiology and Intensive Care Medicine, Donauspital, Vienna, and Vice Chair and Associate Professor, Department of Anesthesiology, University Hospital Bern, Inselspital, Bern, Switzerland.

Address correspondence to Dr. Nemec at the Department of Hospital Pharmacy, Donauspital, Langobardenstrasse 122, 1220 Vienna, Austria (karin.nemec{at}inode.at).

Purpose. Although critically ill patients usually have various central intravenous (i.v.) lines, numerous drugs have to be infused simultaneously through the same lines. This can result in potentially harmful in-line incompatibility that can cause decreased drug effectiveness or increased microparticle load. To minimize the risk of these medication errors at an anesthesia intensive care unit (ICU), the preparation and administration of continuously infused drugs were standardized and the practicability in daily clinical routine was evaluated. Summary. The concentration and diluent of continuously administered i.v. drugs were standardized. The drugs were grouped according to pH, medical indication, and chemical structure. The ICU staff decided to use multilumen central venous catheters, and each group of drugs was assigned to one lumen. Only drugs that belonged to the same group were infused simultaneously through the same lumen; therefore, intragroup incompatibilities had to be excluded before establishing the new drug administration plan at the ICU. The visual compatibility of 115 clinically reasonable intragroup drug mixtures was investigated. All drug combinations were compatible for six hours except mixtures containing thiopental, which was reassigned to a single-line use. In the following year, the practicability of this drug administration plan was evaluated. No deviations were found in the compliance of the staff prescribing and preparing only standardized concentrations and diluents. Further research to investigate the chemical compatibility of the drugs in these multiple mixtures will follow. Conclusion. A project intended to avoid incompatibility among i.v. drugs infused in the intensive care setting included steps to standardize solutions and determine which could be given together. Index terms: Control, quality; Critical illness; Diluents; Drug administration; Errors, medication; Hydrogen ion concentration; Incompatibilities; Injections; Stability; Standards; Storage

 

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