(1243) Safety of Intravenous Push Valproate Compared With Piggyback at a Tertiary Academic Medical Center

Introduction: Data are limited regarding the safety associated with administering valproate (VPA) by intravenous push (IVP) compared with intravenous piggyback (IVPB). The objective of this retrospective pre-post analysis was to compare the safety profile of IVP and IVPB valproate administration.

Methods: This retrospective, pre-post cohort analysis compared patients who received VPA via IVPB from March to May 2022 and IVP from June to August 2022. The major endpoint of this analysis was the incidence of infusion site reactions (infiltration or phlebitis). Additional safety endpoints included bradycardia, hypotension, or sedation attributable to VPA administration. A Naranjo score was calculated for all documented events. Time from pharmacist verification to VPA administration was also collected. Endpoints were analyzed using the Student's t-test, Fisher’s exact test, or chi-square test as appropriate.

Results: A total of 890 IVPB and 440 IVP administrations were included. Phlebitis occurred in 2 (0.2%) and 4 (0.9%) administrations in the IVPB and IVP cohorts, respectively (p = 0.10). Infiltration occurred in 2 (0.2%) and 8 (1.8%) administrations in the IVPB and IVP groups, respectively (p = 0.01). Of note, 3 (0.7%) administrations in the IVP group experienced both infiltration and phlebitis. Based on the Naranjo algorithm, all IVPB and IVP infusion site reactions were classified as possible or doubtful. VPA-induced bradycardia occurred with 8 (0.9%) IVPB and 6 (1.4%) IVP administrations (p = 0.43). All bradycardic events were classified as possible or doubtful. VPA-induced hypotension was observed in 16 (1.8%) IVPB compared to 13 (3.0%) IVP administrations (p = 0.17); 0.2% of these events in each cohort required intervention (p = 1.0). VPA-induced sedation occurred in 59 (6.6%) and 23 (5.2%) administrations in the IVPB and IVP cohorts, respectively (p = 0.32). Of these, 15 IVPB and 11 IVP events were classified as possible; 1 IVPB and 2 IVP events were classified as doubtful. Mean time from pharmacist order verification to VPA administration was 152 and 59 minutes in the IVPB and IVP groups, respectively (p < 0.01).

Conclusions: IVP VPA administration may be considered safe, allowing for more optimal clinical and operational outcomes in the acute care setting.