Physical Simulated Y-Site Compatibility of Hypertonic Saline with Vasoactive Medications Commonly Used in Pediatric Intensive Care
Marissa Roccanova, Delaney Rugan, Anna B O’Brien, Emma L RossAbstract
Purpose
Critically ill pediatric patients often receive multiple IV medications concurrently. Due to limited vascular access in these patients, there is frequent Y-site coadministration. Incompatibility of medications can result in particulate formation, which poses serious clinical risks such as microvascular obstruction and organ dysfunction. This study aims to evaluate the Y-site compatibility of vasoactive medications with 12% hypertonic saline.
Methods
This study simulated Y-site compatibility of 12% hypertonic saline by preparing 1:1 mixing ratios of commonly used medications in pediatric concentrations. Medications that were analyzed included epinephrine, dopamine, norepinephrine, vasopressin, milrinone, alprostadil, and sildenafil. Analysis was completed using visual inspection, pH testing at 0 and 4 hours, and light obscuration to determine particulate counts. Particulate counts were assessed at ≥10 µm and ≥25 µm. Compatibility was defined using USP <788> thresholds.
Results
Of the seven vasoactive medications analyzed in combined with hypertonic saline, six met established compatibility criteria. The range of pH changes among all medications was –0.06 to +0.16, indicating stability over time and limited risk of meaningful acid-base alterations. Sildenafil was the only combination tested that demonstrated incompatibility with 12% hypertonic saline.
Conclusion
This report evaluated the compatibility of vasoactive medications at specific pediatric concentrations with 12% hypertonic saline, demonstrating incompatibility with only sildenafil 0.8 mg/mL. Epinephrine 100 mcg/mL, dopamine in D5W 3.2 mg/mL, alprostadil in D5W 20 mcg/mL, vasopressin in D5W 1 unit/mL, milrinone in D5W 200 mcg/mL, and norepinephrine 32 mcg/mL were all compatible with 12% hypertonic saline.