Harmonising IV Oxycodone with Paediatric Perioperative Medications: A Compatibility Study Through Y-Type Connectors

Abstract

Purpose

Co-administering multiple intravenous (IV) agents via Y-connectors is a common practice in hospitalised and fasting surgical patients. However, there is a lack of reliable data confirming the physical compatibility of some combinations including IV oxycodone, a drug that is gaining increasing popularity in the perioperative period. Concern regarding physical drug incompatibilities precludes concurrent coadministration with other common drugs through a single lumen. This can result in the cessation of infusions to allow the administration of other medications, resulting in exacerbation of acute pain. This study aims to evaluate the physical compatibility of IV oxycodone with some commonly co-administered drugs and IV fluids.

Methods

Mixtures of oxycodone (1mg.mL⁻¹) and the tested drugs and IV fluids were prepared in a ratio of 1:1. The mixtures were examined at 0 and 60 minutes from mixing and assessed using the European Conference Consensus Standards. This involved visual inspection (precipitation, turbidity, colour change, gas formation), spectrophotometry, and pH change. The tested drugs included ketamine, tramadol, clonidine, vancomycin, piperacillin/tazobactam, dexmedetomidine, cefotaxime, gentamicin, and paracetamol. In addition, the commonly used IV fluids tested included glucose 5% + sodium chloride 0.9% + 60 mmol potassium chloride, plasmalyte + dextrose 5%;plasmalyte + dextrose 5% + 55 mmol potassium chloride, plasmalyte + dextrose 5% + 55mmol potassium acetate, plasmalyte + dextrose 5% + 55mmol potassium dihydrogen phosphate, Hartmann’s solution, Standard pediatric Total Parenteral Nutrition (TPN) 20/100 and TPN 25/150.

Results

IV oxycodone (1 mg.mL⁻¹) showed no visual changes; no spectrophotometric absorption variability at 350, 410, or 550nm; and no pH changes of >0.5 at 0 or 60 minutes with any of the tested drugs or fluids in the concentrations tested.

Conclusion

According to European Consensus Conference Standards, IV Oxycodone at 1 mg.mL⁻¹ is physically compatible in a ratio of 1:1 v/v with all investigated drugs and fluids tested for at least 60 minutes.

Graphical Abstract

Keywords:

• analgesia
• physical compatibility
• co-administration
• intravenous fluid
• oxycodone
• Y-connector

Abbreviations

IV, Intravenous; IVC, Intravenous cannula; NCA, Nurse Controlled Analgesia; PCA, Patient Controlled Analgesia; TPN, Total Parenteral Nutrition.

Acknowledgments

We gratefully acknowledge Dr. Michael Ward for his management of all scheduled drugs in this study conducted in the University of South Australia. The abstract of this paper was presented at the Medicines Management 2022, 46^th Society of Hospital Pharmacists of Australia (SHPA) National Conference as a poster presentation with interim findings. The poster’s abstract was published in the book of abstracts available: https://mm2022.shpa.org.au/wp-content/uploads/225.pdf

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

The authors acknowledge the financial support provided the Society of Paediatric Anaesthesia in New Zealand and Australia (SPANZA) (Grant number PG 7111759) and the Women’s and Children’s Hospital Department of Paediatric Anaesthesia Special Purposes fund.