Overfill of common piggyback admixture solutions

Area of Science:

• Pharmaceutical Science
• Clinical Pharmacy
• Drug Delivery Systems

Background:

• Accurate medication preparation is crucial for patient safety.
• Piggyback solutions are commonly used for intravenous drug administration.
• The volume of intravenous admixtures can be affected by container materials and preparation methods.

Purpose of the Study:

• To determine the average final volume of commonly used piggyback solutions.
• To assess the volume discrepancies between labeled and actual volumes of piggyback admixtures.
• To compare the volume differences in various container types, including polyvinyl chloride (PVC) bags.

Main Methods:

• Twenty-three commonly used piggyback solutions were analyzed.
• Solutions were prepared in 50 ml and 100 ml polyvinyl chloride (PVC) containers with 0.9% sodium chloride or 5% dextrose.
• The final volume of ten samples for each drug and dose was measured using a graduated cylinder after complete drainage.

Main Results:

• The final volume of piggyback admixtures consistently exceeded the labeled volume.
• Volume differences were at least 20% in 50 ml PVC containers and 11% in 100 ml PVC containers.
• Alternative containers (FasPak, Viaflex Plus) showed significantly smaller volume differences (2.2%–3.4%) compared to PVC containers.

Conclusions:

• The final volume of piggyback admixtures can be substantially greater than presumed from the label, particularly with PVC containers.
• Healthcare professionals should be aware of potential volume discrepancies when preparing and administering piggyback solutions.
• The choice of IV container significantly influences the final volume accuracy of drug admixtures.