Compatibility of commonly used bone marrow transplant drugs during Y-site delivery

The Y-site compatibility of medications routinely used in bone marrow transplant patients was studied. Two methods were used to evaluate the compatibility of pairs of various i.v. drugs and nutrient fluids. In the first, the drugs were combined in a 1:1 ratio in test tubes, which were visually evaluated immediately and at 1, 4, and 24 hours under normal light and against a white background. The second method involved simulated infusion through a Y-site and a membrane filter. Filter disks were examined under 51 x magnification for precipitates. "Administration" time ranged from one minute to five hours. Most of the combinations were compatible. Exceptions (incompatibilities or inconclusive findings) were amikacin plus a total parenteral nutrient (TPN) admixture; cyclosporine plus dopamine hydrochloride, magnesium sulfate, ondansetron, a parenteral nutrient solution, the TPN admixture, or the TPN admixture with phytonadione; and heparin sodium in either 5% dextrose injection or 0.9% sodium chloride injection plus the TPN admixture or vancomycin. The two study methods were in agreement for all drug combinations except those involving cyclosporine. Cyclosporine in 0.9% sodium chloride injection yielded many fine particles on the filter disk. The combination of cyclosporine with other drugs did not appear to increase the number of particles on the disk, but the results must still be considered inconclusive. Two methods used to determine the compatibility of bone marrow transplant agents when mixed in a Y injection site yielded the same results, except for combinations involving cyclosporine. Most of the combinations were compatible.