Y-site Physical Compatibility of Beta-blocker Infusions with Intensive Care Unit Admixtures

Parenteral beta-blocker therapy via continuous infusion has shown promising results for improved outcomes for patients with septic shock. As patients with septic shock may require multiple intravenous medications, compatibility is necessary to co-infuse these medications through a y-site connector. The purpose of this study was to examine the physical compatibility of select intravenous drugs used for patients with septic shock combined with various intravenous beta-blockers including esmolol, labetalol, and metoprolol through a simulated y-site infusion. The tested drugs included albumin, levothyroxine, acetaminophen, esomeprazole, doripenem, epinephrine, ibuprofen, norepinephrine, levofloxacin, cefepime, ciprofloxacin, meropenem, cisatracurium, and hydrocortisone. Equal volumes of normal saline, esmolol, labetalol, and metoprolol were combined with each test drug at maximum or commercially available concentrations as appropriate used clinically in intensive care units.The samples were examined visually against a white and black background andalso using turbidimetric measurements to determine physical compatibility.Beginning immediately after mixing, observations and analyses were taken over a one-hour period at 15-minute intervals. Each test was performed in triplicate. Many of the test drugs demonstrated visual and/or turbidimetric physical compatibility when combined with esmolol, labetalol, or metoprolol during a simulated y-site infusion. Albumin, cefepime, and hydrocortisone demonstrated physical incompatibility when combined with labetalol and should not be co-infused with labetalol. Esomeprazole and ibuprofen demonstrated physical incompatibility when combined with esmolol and labetalol and should not be co-infused with either beta-blocker. Esmolol and ciprofloxacin mixtures exhibited a statistically significant difference from control solutions and should not be co-infused.