Simulated Y-Site Compatibility of Calcium Gluconate and Benzylpenicillin With Maintenance Fluid Used in Neonatal...

Maintenance fluids for neonates, which are commonly composed of glucose 10%, sodium chloride (NaCl) 0.225% w/v with potassium chloride (KCl) 20 mmol/L (GSP), are administered as a continuous infusion, and prescribed medications are required to be co-administered frequently through a Y-site. There are limited studies on the compatibility of commonly used medicines with this maintenance fluid. Therefore, the objective of this study is to study the compatibility of commonly used medicines in the neonatal intensive care unit with maintenance fluid (GSP). An audit at the RCH Neonatal Intensive Care Unit (NICU) was performed to determine the average doses, durations of infusion, and volumes of maintenance fluid, benzylpenicillin, and calcium gluconate administered. The Y-site chemical compatibility of calcium gluconate with the GSP was determined using a titration method. The Y-site physical compatibility for both calcium gluconate and benzylpenicillin with the GSP was determined on the basis of visual appearance, turbidity, and pH. There was no clinically significant change in pH, turbidity, or concentration of the calcium gluconate at a 1:1, 1:2, 1:4, or 2:1 ratio with GSP with a contact time of up to 4 hours. Both physical and chemical analyses demonstrated the stability of calcium gluconate with GSP at a range of concentrations and time points, indicating Y-site compatibility. Physical changes were detected in the samples containing benzylpenicillin and GSP following the longer interaction time, thus indicating potential Y-site incompatibility. This has been confirmed by both the turbidity and the Z-average tests.