Medication Incompatibilities with Sodium Bicarb

Most of the time ours is piggy-backed into the NS line. If meds need to be given, turn off the bicarb and flush the line w/NS before administering the meds.

May piggyback the bicarb close to the IV site, then when you turn it off and give meds in a more prox. IV port you're sure to have a NS flush preceding the medication.

I'd say second IV line would be best for multiple meds.

When we have someone who needs bicarb, they get another line. Easy to get around incompatibilities that may happen that way. Yes, it is inconvenient for the patient (and the staff who has to start the IV) but it seems to be the best work around. Our cath lab will look at lab values and let us know if the doc may want bicarb so we can start another line.

Tom

At the hospital it work at...it is part of our pre-cath order set to have 2 lines in the pt. We will start two lines in the pt before the cath unless they are a hard stick.
If they have poor venous access we have our iv team or cath lab nurses put them in. As for the Sod Bicarb...we start that the night before ALL of our pt's have open heart (CABG or VALVE or both). They always have two lines in. The only med I know that is compatible with Sod Bicarb is Regular Insulin IV. Our precath pt's with renal insufficency/failure get mucomyst/sod bicarb/or both...and get a second line as well.

Bicarb always has its own line, separate PIV site.

A lot of the older nurses I work with will not run anything with a bicarb gtt. However, after speaking with pharmacy and running drug compatabilities, I have actually found that a few drugs can go with bicarb. This comes in handy when a patient has a bunch of other drips and you need to find where to put abx or what not.

http://www.elephantcare.org/Drugs/sodiumbi.htm (and yes, I realize that this is a veterinary site.... but still applicable)
http://www.ncbi.nlm.nih.gov/pubmed/8733985