A purging procedure for pantoprazole and 4-lumen catheters to prevent IV drug incompatibilities

Pharm World Sci. 2010 Oct;32(5):663-9. doi: 10.1007/s11096-010-9422-9. Epub 2010 Aug 7.


Objective of the study: The purpose of this prospective intervention study was to assess the number of patients with Y-site incompatibilities before and after implementation of quality improvement measures to prevent incompatibilities consisting of a focused instruction for pantoprazole as a drug frequently involved in incompatible drug pairs and of a recommendation to use 4-lumen instead of 3-lumen catheters to increase the number of available central infusion lines.

Setting: Cardiovascular intensive care unit where several standard operating procedures (SOPs) dealing with compatibility were already in place.

Method: In a prospective intervention study, patients' IV medication was assessed for potential incompatibilities using a database containing compatibility information on approximately 60,000 drug pairs. In a first period, routine administration was monitored in 53 consecutive patients (control group). Then, quality improvement measures were implemented recommending a purging procedure before and after bolus administration of pantoprazole as a drug frequently causing incompatibilities in this setting. Additionally, the use of 4-lumen instead of 3-lumen catheters was suggested whenever considered useful by the responsible physicians. The monitoring was repeated during a second period in another 58 patients consecutively admitted to the same unit (intervention group).

Main outcome measure: Overall number of patients with at least one incompatible drug pair and number of patients receiving incompatible pantoprazole combinations.

Results: The number of patients receiving incompatible pantoprazole combinations decreased from 15 of the 15 patients receiving pantoprazole (100.0%) in controls to 9/16 (56.2%) in the intervention group (P < 0.01). The overall number of patients with incompatibilities was not influenced by the intervention with 36/58 (62.1%) compared to controls with 38/53 (71.7%, P = 0.28). The fraction of central lines contributed by four lumen central catheters was larger due to the intervention (80/168 lines, 47.6%) compared to controls (16/184, 8.7%, P < 0.001). Only sporadically there were incompatible combinations of drugs governed by the already existing SOPs.

Conclusion: In an intensive care setting with good SOP adherence, purging before and after administration decreased the respective incompatibility rate whereas the use of 4-lumen instead of 3- lumen catheters had not the expected benefit on separating drug pairs.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • 2-Pyridinylmethylsulfinylbenzimidazoles / administration & dosage*
  • Aged
  • Catheterization, Central Venous / adverse effects*
  • Catheterization, Central Venous / instrumentation
  • Catheters, Indwelling*
  • Drug Incompatibility*
  • Female
  • Humans
  • Infusions, Intravenous
  • Intensive Care Units
  • Male
  • Medication Errors / prevention & control
  • Pantoprazole
  • Prospective Studies


  • 2-Pyridinylmethylsulfinylbenzimidazoles
  • Pantoprazole