Pharmacy World & Science

, Volume 32, Issue 5, pp 663–669 | Cite as

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

  • Thilo Bertsche
  • Carolin Veith
  • Alexander Stahl
  • Torsten Hoppe-Tichy
  • F. Joachim Meyer
  • Hugo A. Katus
  • Walter E. HaefeliEmail author
Research Article


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.


Catheter Drug incompatibility Intensive care units Medication errors Pantoprazole 



We would like to thank the nurses of the ICU for their support in conducting the study and Frank Schröder for generously providing the kik® database.


This study was funded by the University Hospital of Heidelberg, the German Federal State Baden-Württemberg, and in part by a grant from the Association of Pharmacists of Baden-Württemberg.

Conflicts of interest

The authors declared no conflict of interest.


  1. 1.
    Bates DW, Spell N, Cullen DJ, Burdick E, Laird N, Petersen LA, et al. The costs of adverse drug events in hospitalized patients. Adverse Drug Events Prevention Study Group. JAMA. 1997;277:307–11.CrossRefPubMedGoogle Scholar
  2. 2.
    Classen DC, Pestotnik SL, Evans RS, Lloyd JF, Burke JP. Adverse drug events in hospitalized patients. Excess length of stay, extra costs, and attributable mortality. JAMA. 1997;277:301–6.CrossRefPubMedGoogle Scholar
  3. 3.
    Schneeweiss S, Hasford J, Gottler M, Hoffmann A, Riethling AK, Avorn J. Admissions caused by adverse drug events to internal medicine and emergency departments in hospitals: a longitudinal population-based study. Eur J Clin Pharmacol. 2002;58:285–91.CrossRefPubMedGoogle Scholar
  4. 4.
    Classen DC, Pestotnik SL, Evans RS, Burke JP. Computerized surveillance of adverse drug events in hospital patients. JAMA. 1991;266:2847–51.CrossRefPubMedGoogle Scholar
  5. 5.
    Davidsen F, Haghfelt T, Gram LF, Brosen K. Adverse drug reactions and drug non-compliance as primary causes of admission to a cardiology department. Eur J Clin Pharmacol. 1988;34:83–6.CrossRefPubMedGoogle Scholar
  6. 6.
    Mjörndal T, Boman MD, Hägg S, Bäckström M, Wiholm BE, Wahlin A, et al. Adverse drug reactions as a cause for admissions to a department of internal medicine. Pharmacoepidemiol Drug Saf. 2002;11:65–72.CrossRefPubMedGoogle Scholar
  7. 7.
    Bertsche T, Niemann D, Mayer Y, Ingram K, Hoppe-Tichy T, Haefeli WE. Prioritising the prevention of medication handling errors. Pharm World Sci. 2008;30:907–15.CrossRefPubMedGoogle Scholar
  8. 8.
    Taxis K, Barber N. Incidence and severity of intravenous drug errors in a German hospital. Eur J Clin Pharmacol. 2004;59:815–7.CrossRefPubMedGoogle Scholar
  9. 9.
    Bertsche T, Mayer Y, Stahl R, Hoppe-Tichy T, Encke J, Haefeli WE. Prevention of intravenous drug incompatibilities in an intensive care unit. Am J Health Syst Pharm. 2008;65:1834–40.CrossRefPubMedGoogle Scholar
  10. 10.
    Bertsche T, Münk L, Mayer Y, Stahl R, Hoppe-Tichy T, Encke J, et al. Sustained effect of implementation of a standard operation procedure to prevent intravenous drug incompatibilities in an intensive care unit after one year. Am J Health Syst Pharm. 2009;66:1250–3.CrossRefPubMedGoogle Scholar
  11. 11.
    Gikic M, Di Paolo ER, Pannatier A, Cotting J. Evaluation of physicochemical incompatibilities during parenteral drug administration in a paediatric intensive care unit. Pharm World Sci. 2000;22:88–91.CrossRefPubMedGoogle Scholar
  12. 12.
    Höpner JH, Schulte A, Thiessen J, Knuf M, Huth RG. Preparation of a compatibility chart for intravenous drug therapy in neonatal and pediatric intensive care units. Klin Pädiatr. 2007;219:37–43 (article in German).Google Scholar
  13. 13.
    Zeller FP, Anders RJ. Compatibility of intravenous drugs in a coronary intensive care unit. Drug Intell Clin Pharm. 1986;20:349–52.PubMedGoogle Scholar
  14. 14.
    Nemec K, Kopelent-Frank H, Greif R. Standardization of infusion solutions to reduce the risk of incompatibility. Am J Health Syst Pharm. 2008;65:1648–54.CrossRefPubMedGoogle Scholar
  15. 15.
    Laine K, Forsström J, Grönroos P, Irjala K, Kailajärvi M, Scheinin M. Frequency and clinical outcome of potentially harmful drug metabolic interactions in patients hospitalized on internal and pulmonary medicine wards: focus on warfarin and cisapride. Ther Drug Monit. 2000;22:503–9.CrossRefPubMedGoogle Scholar
  16. 16.
    Bjerrum L, Andersen M, Petersen G, Kragstrup J. Exposure to potential drug interactions in primary health care. Scand J Prim Health Care. 2003;21:153–8.CrossRefPubMedGoogle Scholar
  17. 17.
    Kohler GI, Bode-Boeger SM, Busse R, Hoopmann M, Welte T, Boger RH. Drug-drug interactions in medical patients: effects of in-hospital treatment and relation to multiple drug use. Int J Clin Pharmacol Ther. 2000;38:504–13.PubMedGoogle Scholar
  18. 18.
    Bertsche T, Pfaff J, Schiller P, Kaltschmidt J, Pruszydlo MG, Stremmel W, Walter-Sack I, Haefeli WE, Encke J. Prevention of adverse drug reactions in intensive care patients by personal intervention based on an electronic clinical decision support system. Intensive Care Med. 2010;36:665–72.CrossRefPubMedGoogle Scholar
  19. 19.
    Thur MP, Miller WA, Latiolais CJ. Medication errors in a nurse-controlled parenteral admixture program. Am J Hosp Pharm. 1972;29:298–304.PubMedGoogle Scholar
  20. 20.
    Schwartau NW, Schwerman EA Jr, Thompson CO, Hauff K. A comprehensive intravenous admixture system. Am J Hosp Pharm. 1973;30:607–10.PubMedGoogle Scholar
  21. 21.
    Folli HL, Poole RL, Benitz WE, Russo JC. Medication error prevention by clinical pharmacists in two children’s hospitals. Pediatrics. 1987;79:718–22.PubMedGoogle Scholar
  22. 22.
    Schneider MP, Cotting J, Pannatier A. Evaluation of nurses’ errors associated in the preparation and administration of medication in a pediatric intensive care unit. Pharm World Sci. 1998;20:178–82.CrossRefPubMedGoogle Scholar
  23. 23.
    Bigley FP, Forsyth RJ, Henley MW. Compatibility of imipenem-cilastatin sodium with commonly used intravenous solutions. Am J Hosp Pharm. 1986;43:2803–9.PubMedGoogle Scholar
  24. 24.
    Trissel LA, Martinez JF. Compatibility of piperacillin sodium plus tazobactam with selected drugs during simulated Y-site injection. Am J Hosp Pharm. 1994;51:672–8.PubMedGoogle Scholar
  25. 25.
    Baririan N, Chanteux H, Viaene E, Servais H, Tulkens PM. Stability and compatibility study of cefepime in comparison with ceftazidime for potential administration by continuous infusion under conditions pertinent to ambulatory treatment of cystic fibrosis patients and to administration in intensive care units. J Antimicrob Chemother. 2003;51:651–8.CrossRefPubMedGoogle Scholar
  26. 26.
    Vogel Kahmann I, Bürki R, Denzler U, Höfler A, Schmid B, Splisgardt H. Incompatibility reactions in the intensive care unit. Five years after the implementation of a simple “colour code system”. Anaesthesist. 2003;52:409–12. (article in German).CrossRefPubMedGoogle Scholar
  27. 27.
    Hasegawa GR, Eder JF. Visual compatibility of amiodarone hydrochloride injection with other injectable drugs. Am J Hosp Pharm. 1984;41:1379–80.PubMedGoogle Scholar
  28. 28.
    Benedict MK, Roche VF, Banakar UV, Hilleman DE. Visual compatibility of amiodarone hydrochloride with various antimicrobial agents during simulated Y-site injection. Am J Hosp Pharm. 1988;45:1117–8.PubMedGoogle Scholar
  29. 29.
    Chalmers JR, Bobek MB, Militello MA. Visual compatibility of amiodarone hydrochloride injection with various intravenous drugs. Am J Health Syst Pharm. 2001;58:504–6.PubMedGoogle Scholar
  30. 30.
    Zeisler J, Alagna C. Incompatibility of labetalol hydrochloride and furosemide. Am J Hosp Pharm. 1993;50:2521–2.PubMedGoogle Scholar
  31. 31.
    Palmquist KL, Quattrocchi FP, Looney LA. Compatibility of furosemide with 20% mannitol. Am J Health Syst Pharm. 1995;52:648–50.PubMedGoogle Scholar
  32. 32.
    Tyler LS, Rehder TL, Davis RB. Effect of gentamicin on heparin activity. Am J Hosp Pharm. 1981;38:537–40.PubMedGoogle Scholar
  33. 33.
    Condie CK, Tyler LS, Barker B, Canann DM. Visual compatibility of caspofungin acetate with commonly used drugs during simulated Y-site delivery. Am J Health Syst Pharm. 2008;65:454–7.CrossRefPubMedGoogle Scholar
  34. 34.
    Steinijans VW, Huber R, Hartmann M, Zech K, Bliesath H, Wurst W, Radtke HW. Lack of pantoprazole drug interactions in man: an updated review. Int J Clin Pharmacol Ther. 1996;34(1 Suppl):S31–50.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2010

Authors and Affiliations

  • Thilo Bertsche
    • 1
  • Carolin Veith
    • 1
  • Alexander Stahl
    • 2
  • Torsten Hoppe-Tichy
    • 3
  • F. Joachim Meyer
    • 2
  • Hugo A. Katus
    • 2
  • Walter E. Haefeli
    • 4
    Email author
  1. 1.Cooperation Unit Clinical PharmacyUniversity of HeidelbergHeidelbergGermany
  2. 2.Department of Internal Medicine III, CardiologyUniversity of HeidelbergHeidelbergGermany
  3. 3.Pharmacy DepartmentUniversity Hospital of HeidelbergHeidelbergGermany
  4. 4.Department of Clinical Pharmacology and PharmacoepidemiologyUniversity of HeidelbergHeidelbergGermany

Personalised recommendations