Hi everyone! A while back, I made a post about concerns with Myxredlin (insulin regular) bags from Baxter having a phosphate buffer and the fact that it's listed as compatible with calcium chloride and calcium gluconate in Lexi-comp and Micromedex. Lexi-comp actually has the name "Myxredlin" listed in parenthesis when you enter it into a compatibility search. I reached out to an MSL from Baxter for some more information and got the following information:

-There are 5 mmol/L of phosphate in these bags
-Baxter has not conducted studies evaluating y-site compatibility of MYXREDLIN and IV Solutions or other medications, and does not have additional data to provide outside of the prescribing information.

We did an in-house test mixing insulin with calcium gluconate at with different volumes, and did notice visible precipitate in 3 of our syringes, most notably when insulin (phosphate) was in excess. I am going to report out to ISMP, but from my experience, visual inspection is no longer an acceptable sole method of compatibility for Trissel's. Do any academic institutions have the equipment to perform an actual compatibility study/ would be interested in partnering?
At the very least, great topic for discussion and one that I think needs to be escalated as I'm sure there are many other pre-mixed IV solutions that have phosphate buffers that may be putting patients at risk.