# Drug Incompatibilities and Complex Assemblies: Let Us Remain Vigilant!

## TL;DR

A case study shows that even with special devices, drug incompatibilities can still happen in neonatal care, requiring strict attention to preparation and prescriptions.

## Contribution

Highlights a real-world PCI incident in neonatal care despite using a multi-lumen device, emphasizing the need for vigilance in drug preparation.

## Key findings

- A PCI occurred due to a dilution error in ganciclovir administration, leading to a white precipitate.
- The presence of lipids in parenteral nutrition made the precipitate hard to detect visually.
- Multi-lumen devices do not fully prevent PCIs if preparation errors occur.

## Abstract

Background/Objectives: Multi-lumen devices that limit physicochemical incompatibilities (PCIs) are frequently used in neonatal intensive care units where premature infants receive numerous infusions. The aim of the study was to investigate a PCI that occurred despite the use of a device of this type (EDELVAISS® Multiline NEO, Doran International, Toussieu, France). Case Summary: A 7-week-old preterm infant received ganciclovir at therapeutic dosage for cytomegalovirus (CMV) infection. After the fifth administration of ganciclovir, a PCI occurred, leading to a white precipitate. The peripheral inserted central catheter (PICC) (PREMICATH®2Fr, Vygon, Ecouen, France) had to be replaced. Laboratory reproduction of the administrations during 72 h, nuclear magnetic resonance (NMR) analysis and particle counting were carried out to analyse the occurrence of events leading to PCIs. The precipitate was linked to a PCI of parenteral nutrition associated with a dilution error of ganciclovir (omission of a 10-fold dilution step, resulting in ganciclovir being administered at 30 mg/L instead of 3 mg/L). Due to the presence of lipids in the parenteral nutrition, visual detection of the white precipitate was difficult. Conclusions: Multi-lumen infusion devices limit but do not prevent the occurrence of PCIs, particularly in the event of a preparation error. Despite the use of this type of device, great vigilance is still required, particularly with regard to prescription analysis and reconstitution procedures.