Intravenous Physical Compatibility of Heparin Sodium and Furosemide

Continuous infusions of heparin and furosemide are often required for hospitalized patients to treat cardiac-related disease states. Concomitant infusion of heparin and furosemide through the same intravenous line minimizes the need for multiple intravenous sites. For concomitant infusions to be administered, knowledge of the physical compatibility for intravenous medications is imperative for patient safety and administering medications to maximize their effectiveness. Currently, heparin and furosemide are listed as Y-site compatible, but precipitation was reported at a large academic medical center, which questions this compatibility. This study investigated the in vitro physical compatibility of heparin sodium premix 25,000 units/250 mL in dextrose 5% water from two different manufacturers with furosemide 40 mg/4 mL at concentrations of 4:1 for heparin sodium and furosemide. The admixtures were prepared in triplicate using aseptic technique, stored at 19°C to 24°C and examined for visual precipitation, turbidity, and pH change at baseline, 1, 5, 8, 24, and 48 hours. Heparin sodium, B. Braun Medical Inc. or Hospira, Inc. solutions, and furosemide admixtures revealed changes over 48 hours. Changes in visual appearance, absorbance, and pH were observed at hour 5 compared to baseline for the B. Braun Medical Inc. admixture. The Hospira, Inc. admixture revealed visual changes by hour 48, but demonstrative changes in absorbance and pH did not occur. Our observations found demonstrative changes in physical compatibility in the admixtures of heparin sodium and furosemide at a ratio of 4:1. The findings suggest that a combination of the solutions in this study be avoided until further research is completed.