Have you all had any reported concerns for Y-site administration of Zosyn + LR?

Background: This combination has an uncertain rating with variable results in Lexicomp’s Trissels IV Compatibility evaluation. It recommends ensuring that the Zosyn formulation contains EDTA if it will be co-administered with LR via Y-site. The studies do not specify the type of formulation. Zosyn’s older formulations were not noted to be compatible with LR. Once reformulated with EDTA and sodium citrate, it was deemed compatible. We reviewed the products on the market and determined that most vials of lyophilized power do not contain EDTA and sodium citrate. The premixed frozen solution GALAXY bags from Baxter and Wyeth contain EDTA and sodium citrate as stabilizing agents, and they are compatible with LR.

Questions: I would love to hear the perspective of how other institutions are handling this concern. I appreciate any insight you may be able to provide.

• Have you had any reports of compatibility issues with Zosyn + LR?
• What Zosyn products are you using? (premixed frozen products or vials with powder for reconstitution)
• Does your institution specify to only purchase Zosyn products containing EDTA?
• Do you generally recommend that nursing avoid Y-site administration of Zosyn and LR?