Compatibility of Drugs (2024)

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  • Mauro Pittiruti4 &
  • Giancarlo Scoppettuolo5

  • 780 Accesses

  • 1 Citations

Abstract

Venous access devices (VADs) are commonly used for the infusion of solutions with extremely variable characteristics in terms of pH, osmolarity, viscosity, and so on. Some of these solutions have the potentiality of bringing damage to the endothelium, by very different mechanisms; though, this damage is not likely to occur when the solution is rapidly diluted in the blood flow. This concept is at the basis of the differentiation between solutions ‘compatible’ with the peripheral route and solutions that—on the contrary—require to be administered via a central line. The blood flow in the superior vena cava (approximately 2L/min) may be 200 times higher than the blood flow in a superficial vein of the forearm (approximately 10mL/min), so that an irritant or vesicant solution infused in a central VAD that has the tip in the superior vena cava is immediately diluted and does not exert any damage on the endothelium of the vein wall; on the other hand, the same solution—if administered by a short cannula into a small superficial vein of the forearm—is likely to interact with the endothelium causing local inflammation and thrombosis (i.e., a thrombophlebitis). There is a long list of solutions that should be preferably infused via central VADs, i.e., VADs with their tip in the superior vena cava (SVC), or right atrium (RA), or inferior vena cava (IVC):If these solutions are administered by a peripheral route for a prolonged period, local complications such as phlebitis and thrombosis are very likely to occur. Thrombosis secondary to chemical damage is a very frequent cause of catheter failure for any peripheral VAD, not only short cannulas but also long peripheral catheters and midline catheters. Repeated episodes of thrombophlebitis of the superficial veins lead to a progressive depletion of the venous patrimony, which is particularly feared in the pediatric patient. In any patient, but particularly in infants and children, whenever the prolonged intravenous infusion of an irritant/vesicant solution is planned, a central VAD should also be planned.

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Authors and Affiliations

  1. Department of Surgery, Catholic University Hospital, Rome, Italy

    Mauro Pittiruti

  2. Department of Infective Diseases, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy

    Giancarlo Scoppettuolo

Authors

  1. Mauro Pittiruti

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  2. Giancarlo Scoppettuolo

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Editor information

Editors and Affiliations

  1. Intensive Care Unit, Department of Emergency, Anesthesiology and Intensive Care, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy

    Daniele G. Biasucci

  2. Head of Research and Innovation Unit, Department of Anesthesia, Istituto Giannina Gaslini, Genova, Italy

    Nicola Massimo Disma

  3. Department of Surgery, Catholic University Hospital, Rome, Italy

    Mauro Pittiruti

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Compatibility of Drugs (1)

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Pittiruti, M., Scoppettuolo, G. (2022). Compatibility of Drugs. In: Biasucci, D.G., Disma, N.M., Pittiruti, M. (eds) Vascular Access in Neonates and Children. Springer, Cham. https://doi.org/10.1007/978-3-030-94709-5_22

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