The concurrent administration of intravenous (IV) medications with parenteral nutrition admixtures through the same IV line in paediatric patients poses clinically significant compatibility challenges. To assist clinicians and clinical pharmacists in decision-making and reducing these risks, an Irish research team recently developed and piloted a dedicated risk assessment tool.
Assessing compatibility between IV medications and parenteral nutrition is challenging as published data often reflect specific testing conditions. Outcomes can vary based on materials, experimental design or the specific types and concentrations of both IV medications and parenteral nutrition admixtures.
Recognising these nuances helps clinicians and clinical pharmacists apply data more carefully and maintain patient safety.
Risk assessment tool development
Building on this understanding, the researchers aimed to develop and pilot a risk assessment tool that helped to evaluate compatibility risks in paediatric patients and assist clinical judgement.
Their instrument development followed a structured, stepwise approach beginning with a literature review on existing compatibility data. Next, they designed and refined a risk assessment instrument, incorporating an IV medication classification system.
They then piloted the tool by evaluating potential incompatibility risks between parenteral nutrition admixtures and two commonly used IV drugs: adrenaline and morphine. Pilot testing demonstrated how the risk assessment tool could assist with making an informed decision on co-administration of IV medications and parenteral nutrition.
Aiding clinical judgement
The researchers acknowledged that limited published research on certain IV medications warranted caution when interpreting the tool’s outputs. ‘This risk assessment tool should be used to aid, but not replace, clinical judgment in determining the degree of incompatibility risk,’ they noted.
The researchers further emphasised the need for ongoing clinical assessment and local compatibility studies that reflect unique practice conditions. The assessment tool was also useful in highlighting data gaps that warrant further study.
The next phase of the study involves a national survey in Ireland to gauge medical and nursing staff awareness of parenteral nutrition compatibility issues.
The long-term goal is an artificial intelligence-based application that tailors IV medication and parenteral nutrition recommendations to each patient’s clinical scenario, offering a promising step forward in paediatric care.
Reference
Farhan M, Bennett J, Cram A, McCallion N, O’Brien F. Risk assessment tool for compatibility of concurrent administration of intravenous medications with parenteral nutrition admixture. Eur J Pharm Biopharm. 2025 Feb;207:114614. doi: 10.1016/j.ejpb.2024.114614. Epub 2024 Dec 16. PMID: 39694078.
