PARENTERAL NUTRITION (PN) AND DRUG COMPATIBILITY PARENTERAL NUTRITION (PN) AND DRUG COMPATIBILITY The co-infusion of drugs and PN should be avoided. PN solutions are diverse in their The co-infusion of drugs and PN should be avoided. PN solutions are diverse in their composition and compatibilities with drugs can never be guaranteed. Drugs administered composition and compatibilities with drugs can never be guaranteed. Drugs administered to patients receiving PN should be given through a separate IV site or catheter lumen. If to patients receiving PN should be given through a separate IV site or catheter lumen. If a separate site is not available, the drug may be given through a separate line that has a separate site is not available, the drug may be given through a separate line that has a Y-connection to the PN line as close to the patient as possible. The PN should not a Y-connection to the PN line as close to the patient as possible. The PN should not be running and the common tubing must be adequately flushed before and after drug be running and the common tubing must be adequately flushed before and after drug administration. administration. Only if a patient’s clinical status requires uninterrupted PN administration can drugs Only if a patient’s clinical status requires uninterrupted PN administration can drugs on the following list be administered through the same Y-connection with the PN (amino on the following list be administered through the same Y-connection with the PN (amino acid/dextrose) still running. Note that drugs in the list have not been tested with lipids acid/dextrose) still running. Note that drugs in the list have not been tested with lipids as visual compatibility with opaque fat solution is not possible. These drugs have been as visual compatibility with opaque fat solution is not possible. These drugs have been co-infused with total PN (amino acid/dextrose/lipids) in the past without problems, but co-infused with total PN (amino acid/dextrose/lipids) in the past without problems, but patients should be monitored for clinical effect when possible. patients should be monitored for clinical effect when possible. cefotaxime gentamicin meperidine penicillin G cefotaxime gentamicin meperidine penicillin G ceftazidime heparin methylprednisolone piperacillin ceftazidime heparin methylprednisolone piperacillin clindamycin hydrocortisone metoclopramide ranitidine clindamycin hydrocortisone metoclopramide ranitidine cloxacillin hydromorphone metronidazole tobramycin cloxacillin hydromorphone metronidazole tobramycin cyclosporine insulin (regular) morphine (up to 1 mg/mL) cyclosporine insulin (regular) morphine (up to 1 mg/mL) dopamine isoproterenol norepinephrine vancomycin dopamine isoproterenol norepinephrine vancomycin fluconazole lidocaine fluconazole lidocaine Note that this compatibility refers to Y-site admixture only; drugs must not be added to PN Note that this compatibility refers to Y-site admixture only; drugs must not be added to PN bags. bags. The following drugs are INCOMPATIBLE with PN and MUST NOT be run concurrently The following drugs are INCOMPATIBLE with PN and MUST NOT be run concurrently with PN solutions under any circumstances. These drugs may be administered through with PN solutions under any circumstances. These drugs may be administered through a Y-connection provided the PN solution is stopped, the line clamped immediately above a Y-connection provided the PN solution is stopped, the line clamped immediately above the Y and the line adequately flushed. the Y and the line adequately flushed. acetazolamide calcium doxorubicin phenytoin acetazolamide calcium doxorubicin phenytoin acyclovir cefazolin etoposide phosphate acyclovir cefazolin etoposide phosphate amphotericin ceftriaxone furosemide sodium bicarbonate amphotericin ceftriaxone furosemide sodium bicarbonate ampicillin cisplatin mannitol ampicillin cisplatin mannitol ATG deferoxamine paraldehyde ATG deferoxamine paraldehyde For any drugs not listed here, the prescribing physician should discuss with For any drugs not listed here, the prescribing physician should discuss with the pharmacist the information available on the drug and the risks/benefits of co- the pharmacist the information available on the drug and the risks/benefits of co- infusing a particular drug with PN The physician decides to run (or not to run) a drug infusing a particular drug with PN The physician decides to run (or not to run) a drug simultaneously with PN This decision is documented as a physician’s order e.g. “Drug X simultaneously with PN This decision is documented as a physician’s order e.g. “Drug X may be run concurrently with PN” may be run concurrently with PN” NOTE: Whenever drugs are co-infused with PN, the lines should be carefully NOTE: Whenever drugs are co-infused with PN, the lines should be carefully monitored for signs of incompatibility (e.g. precipitation, color change). monitored for signs of incompatibility (e.g. precipitation, color change). PARENTERAL NUTRITION (PN) AND BLOOD PRODUCT COMPATIBILITY PARENTERAL NUTRITION (PN) AND BLOOD PRODUCT COMPATIBILITY No blood products are to be co-infused with PN. No blood products are to be co-infused with PN. Furosemide injection is permitted with Albumin for Renal Dialysis patients only. Furosemide injection is permitted with Albumin for Renal Dialysis patients only. 9 9.