Y-site physical compatibility of intensive care unit admixtures with cisatracurium

Purpose: Critically ill patients often require multiple intravenous (IV) continuous infusions throughout their intensive care unit (ICU) stay, sometimes necessitating the co-administration of medications in patients with limited access. IV compatibility of these medications is lacking, with recent drug shortages requiring practitioners to utilize therapies with little to no compatibility data. This study will examine the physical compatibility of the neuromuscular blocking agent cisatracurium with selected continuous infusion therapies.

Methods: Physical compatibility was checked in triplicate using visual assessment against both light and dark backgrounds and non-visual changes in turbidity with a turbidimeter. Assessments were made in 15 minutes increments up to 1 hour, to account for contact time in a simulated y-site. A measured turbidity difference of less than 0.5 NTU was considered compatible. Analysis of variance was used to determine statistical difference between the experimental groups and controls.

Results: Calcium gluconate, diltiazem, esomeprazole, regular insulin, nicardipine, and vasopressin demonstrated no evidence of physical incompatibilities with cisatracurium after visual and turbidimetric assessment. Although the presence of particles, haze, gas formation or alteration of color were not visibly notable in admixtures of pantoprazole with cisatracurium, the turbidity of the admixtures was 0.31 +/- 0.21 NTU greater than controls. Although less than the 0.5 NTU benchmark, the turbidity of pantoprazole admixtures was statistically different from that of controls (p< 0.001). Additionally, cisatracurium-pantoprazole admixtures demonstrated an increase in turbidity over 60 minutes of 0.44 +/- 0.26 NTU.

Conclusions: Practice guidelines require a minimum of physical compatibility to co-administer IV medication therapies. Calcium gluconate, diltiazem, esomeprazole, regular insulin, nicardipine, and vasopressin demonstrated physical compatibility with cisatracurium over a 1 hour period. Cisatracurium and pantoprazole should not be co-administered at this time due a statistical difference in compatibility between control and experimental groups.