Incompatibility of IV admixture administration among hospitalized patient at Referral Hospital in Banyumas Regional

Erza Genatrika; Wahyu Utaminingrum; Tsabita Maryam Afurisac

doi:10.35814/jifi.v24i1.2085

Authors

Erza Genatrika Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, Universitas Muhammadiyah Purwokerto, Purwokerto, 53182, Indonesia
Wahyu Utaminingrum Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Muhammadiyah Purwokerto, Purwokerto, 53182, Indonesia
Tsabita Maryam Afurisac Undergraduate Student, Faculty of Pharmacy, Universitas Muhammadiyah Purwokerto, Purwokerto, 53182, Indonesia

DOI:

https://doi.org/10.35814/jifi.v24i1.2085

Keywords:

IV admixtures;, banyumas, crystals, incompatibilities

Abstract

Drug administration to inpatients in referral hospitals is generally performed using intravenous (IV) admixtures. IV admixtures can cause incompatibility problems that can affect the stability and bioavailability of the drugs. This study aimed to determine the potential for incompatibility problems in administering IV admixtures to inpatients in referral hospitals in the Banyumas region. This was a descriptive observational study. Data collection was carried out prospectively with the inclusion criteria of non-cytostatic IV admixtures administered to inpatients from March to May 2024. The potential for incompatibility in IV admixtures was determined based on visual observations and pH values carried out in the laboratory. In addition, we analyzed the Handbook of Injectable Drugs. The results of the study showed that 1516 IV admixtures were obtained within 3 months. Of the 1516 IV admixtures, 40 different IV admixtures had different characteristics. The characteristics of IV admixtures obtained at this referral hospital consisted of IV admixtures-small volume parenteral (36%), IV admixtures-large volume parenteral (5%), and reconstitution (59%). The solvents used included water for injection (94.65%), NaCl 0.9%, and RingerLactate (1.39%). Incompatibility occurred in a mixture of Sodium Phenytoin 50 mg/mL with NaCl 0.9% at concentrations as high as 0.264% (4 occurrences out of 1516 IV mixtures), characterized by the formation of crystals after mixing. From this study, it can be concluded that the administration of IV admixtures to inpatients at the Banyumas Referral Hospital has a low potential for incompatibility (0.264%). However, the mixture of sodium phenytoin with 0.9% NaCl has been proven to cause crystal formation due to a decrease in pH, thus requiring special attention in the practice of mixing intravenous drugs.

References

[1] J. Bentley, K. Heard, G. Collins, and C. Chung, “Mixing medicines: how to ensure patient safety,” The Pharmaceutical Journal, vol. 294, no. 7859, pp. 294–7, 2015.

[2] C. Häni, P. Vonbach, C. Fonzo-Christe, S. Russmann, V. Cannizzaro, and D. F. Niedrig, “Evaluation of Incompatible Coadministration of Continuous Intravenous Infusions in a Pediatric/Neonatal Intensive Care Unit,” The Journal of Pediatric Pharmacology and Therapeutics, vol. 24, no. 6, pp. 479–488, Nov. 2019, doi: 10.5863/1551-6776-24.6.479.

[3] A. U. Salamah and F. Kurniawati, “Potential Incompatibility Problem of Intravenous Drugs Administration Among Intensive Care Unit (ICU) patients in PKU Muhammadiyah Yogyakarta Hospital,” JMPF, vol. 9, no. 4, pp. 238–242, 2019.

[4] E. Genatrika, Pedoman Dasar Penyiapan Produk Steril Non Sitostatika. Purwokerto: UMP Press, 2023.

[5] Depkes RI, Pedoman Pencampuran Obat Suntik dan Penanganan Sediaan Sitostatika. 2009.

[6] E. P. Ningrum, F. Rahmawati, M. D. Laksitorini, and E. Lukitaningsih, “Physical and Chemical Compatibility Testing of Intravenous Phenytoin Preparations In 0.9% Normal Saline Solution,” Tropical Journal of Natural Product Research, vol. 8, no. 11, pp. 9192–9198, Dec. 2024, doi: 10.26538/tjnpr/v8i11.31.

[7] A. D. Purwaningsih and L. M. Cahyo, “Studi Inkompatibilitas Parenteral dan Penggunaan Antibiotika Pada Pasien Rawat Inap Di Rumah Sakit Surakarta,” Jurnal Farmasi Indonesia, vol. 15, no. 2, Art. no. 2, Nov. 2018, doi: 10.31001/jfi.v15i2.452.

[8] S. Hanifah, P. Ball, and R. Kennedy, “Medication Incompatibility in Intravenous Lines in a Paediatric Intensive Care Unit (PICU) of Indonesian Hospital,” Crit Care Shock, vol. 21, no. 3, p. 11, 2018.

[9] D. Dewantisari and I. Musfiroh, “Strategi Peningkatan Objektivitas Hasil Uji Inspeksi Visual Sediaan Injeksi : Review,” Majalah Farmasetika, vol. 5, no. 2, pp. 64–72, Feb. 2020, doi: 10.24198/mfarmasetika.v5i2.26017.

[10] L. Djerroud, G. Leclair, T. Sullivan, and V. Dagenais-Beaulé, “Visual compatibility and particle counter evaluations of syringes of intramuscular psychotropic coadministered solutions,” Eur J Hosp Pharm, vol. 30, no. e1, pp. e97–e100, Mar. 2023, doi: 10.1136/ejhpharm-2022-003378.

[11] H. Ding, T. Tong, S. Liu, L. Tang, and Z. Chen, “Medication Safety in Intravenous Therapy: Compatibility of Etoposide with Frequently Drugs Used in Tumour Critical Care During Simulated Y-Site Administration,” DDDT, vol. 19, pp. 1147–1161, Feb. 2025, doi: 10.2147/DDDT.S489534.

[12] M. Mazaheri et al., “Monitoring of Visible Particles in Parenteral Products by Manual Visual Inspection—Reassessing Size Threshold and Other Particle Characteristics that Define Particle Visibility,” Journal of Pharmaceutical Sciences, vol. 113, no. 3, pp. 616–624, Mar. 2024, doi: 10.1016/j.xphs.2023.10.002.

[13] L. A. Trissel, Handbook on Injectable Drugs, 15th ed. Bethesda, MD: American Society of Health-System Pharmacists, 2013.

[14] A. Gray, J. Wright, V. Goodey, and L. Bruce, Injectable Drugs Guide. London: Pharmaceutical Press, 2011.

[15] Kemenkes RI, Farmakope Indonesia, Edisi VI. Jakarta: Kementerian Kesehatan Republik Indonesia, 2020.

[16] O. Machotka, J. Manak, A. Kubena, and J. Vlcek, “Incidence of intravenous drug incompatibilities in intensive care units,” Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub, vol. 159, no. 4, pp. 652–656, Dec. 2015, doi: 10.5507/bp.2014.057.

[17] S. K. Gupta, “Water for Pharmaceutical Use,” International Journal of Pharmaceutical Sciences Review and Research, vol. 36, no. 1, pp. 199–204, 2016.

[18] L. Maharani, A. Astuti, and A. Achmad, “Parenteral Admixture Compatibility in Neurosurgery Ward in Prof. Dr. Margono Soekarjo Regional Public Hospital,” Indonesian Journal of Clinical Pharmacy, vol. 3, no. 1, pp. 1–9, 2014, doi: 10.15416/ijcp.2014.3.1.1.

[19] H. Raoulji and A. Kapadia, “PREVENTION OF PHENYTOIN PRECIPITATION IN INFUSION FLUIDS,” IJAR, pp. 69–70, Dec. 2022, doi: 10.36106/ijar/7405078.

[20] S. Tomczak et al., “Stability and Compatibility Aspects of Drugs: The Case of Selected Cephalosporins,” Antibiotics, vol. 10, no. 5, p. 549, May 2021, doi: 10.3390/antibiotics10050549.

[21] ASHP, “ASHP® Injectable Drug InformationTM: A Comprehensive Guide to Compatibility and Stability,” in ASHP® Injectable Drug InformationTM, ASHP, 2021. Accessed: Dec. 13, 2024. [Online]. Available: https://publications.ashp.org/display/book/9781585286850/9781585286850.xml

[22] R. W. Leopoldino, H. T. Costa, T. X. Costa, R. R. Martins, and A. G. Oliveira, “Potential drug incompatibilities in the neonatal intensive care unit: a network analysis approach,” BMC Pharmacology and Toxicology, vol. 19, no. 1, p. 83, Dec. 2018, doi: 10.1186/s40360-018-0265-7.

[23] C. Aeberhard, C. Steuer, C. Saxer, A. Huber, Z. Stanga, and S. Mühlebach, “Physicochemical stability and compatibility testing of levetiracetam in all-in-one parenteral nutrition admixtures in daily practice,” European Journal of Pharmaceutical Sciences, vol. 96, pp. 449–455, Jan. 2017, doi: 10.1016/j.ejps.2016.10.015.

[24] L. Anez-Bustillos, D. T. Dao, M. A. Baker, G. L. Fell, M. Puder, and K. M. Gura, “Review: Lipid Formulations for the Adult and Pediatric Patient: Understanding the Differences,” Nutr Clin Pract, vol. 31, no. 5, pp. 596–609, Oct. 2016, doi: 10.1177/0884533616662996.

[25] G. L. Zipp and N. Rodríguez-Hornedo, “The mechanism of phenytoin crystal growth,” International Journal of Pharmaceutics, vol. 98, no. 1, pp. 189–201, Aug. 1993, doi: 10.1016/0378-5173(93)90056-L.

[26] S. Hanifah, “Identifikasi pH Obat-Obat Yang Digunakan di Pediatric Intensive Care Unit (PICU) Untuk Pencegahan Inkompatibilitas Intravena,” Jurnal Ilmiah Farmasi, vol. 11, no. 2, pp. 30–65, 2015.

[27] E. Genatrika, I. Puspitasari, S. A. Kristina, and T. N. S. Sulaiman, “Personnel knowledge of intravenous admixtures: a survey in a government hospital,” The Pan African Medical Journal, vol. 40, no. 198, Art. no. 198, Dec. 2021, doi: 10.11604/pamj.2021.40.198.30093.

[28] E. Genatrika, I. Puspitasari, S. A. Kristina, and T. N. S. Sulaiman, “Suitability in compounding sterile preparations: An observational study in a referral hospital,” J Pharm Pharmacogn Res, vol. 10, no. 2, pp. 338–348, Mar. 2022, doi: 10.56499/jppres21.1305_10.2.338.

[29] F. N. Ulfa, Efta Triastuti, and A. Achmad, “Uji Kesesuaian Aseptic Dispensing Berdasarkan Pedoman Dasar Dispensing Sediaan Steril Departemen Kesehatan RI di ICU dan NICU RSUD Dr . Saiful Anwar Malang,” Pharmaceutical Journal of Indonesia, vol. 3, no. 1, pp. 33–38, 2017.