NTG IV and compatability

RNCENCCRNNREMTP · May 15, 2004

Dear JaimealmostRN,
I wish I still had a hardcopy of the article on IV heparin and NTG but it's been alot of years since I read the article in the AACN journal for critical care. As I remember it, the findings were that if you run NTG and Heparin together (at the Y-site) there is a problem with obtaining accurate PTT readings. Therefore, you will see that most policies require a separate line for NTG infusions.
:)

Here is some info on nitro and heparin:

Andrew Bowman

"Lack of in vitro interaction between heparin and NTG"

American Journal of Clinical Pathology

March 1996

"No direct effect of NTG on the anticoagulant effect of heparin was observed as measured by aPTT"

"The effect of simultaneous IV administration of NTG and heparin on PTT"

Military Medicine September 1995

"This study indicates no significant difference in PTT in subjects receiving these infusions via separate or SAME IV sites"

"Interaction of IV heparin and organic nitrates in acute ischemic syndromes"

AJC October 1995

"The heparin dose did not show a significant correlation to the dose of IV NTG"

"A clinical and in vitro study on the possible interaction of IV nitrates with heparin anticoagulation"

Clinical Cardiology December 1994

"Nitrates had no effect on heparin activity in vitro"

"NTG induced heparin resistance"

Military Medicine August 1994

"Results show no inhibition of heparin anticoagulation by IV NTG at clinically relevant doses"

"Effects of IV NTG on heparin dosage requirements"

AJC August 1993

"Clinically significant heparin resistance was not found"

"Assessment of the drug interaction between IV NTG and heparin"

Annals of Pharmacotherapy December 1992

"Study demonstrates a clinically insignificant interaction between NTG and heparin at NTG doses commonly used in patients"

"Absence of NTG induced heparin resistance in healthy volunteers"

European Heart Journal

March 1992

"A previously described NTG induced heparin resistance could not be verified by in vitro experiments or in a randomized, double-blind, crossover trial in healthy volunteers"

rnmaven · May 18, 2004

Thanks for the Literature Search! Great references.......I'll keep them on file. I think the bottom line is that we still have to follow whatever the policy is at our respective institutions. Thanks for bringing us up to date......maybe we can use this info to change some policies!

NYERRN · May 19, 2004

Hi everyone. I have a question about Nitro IV. In my Davis' Drug guide it says that the manufacturers don't recomend mixing or adding anything to it or running it with anything else. I have also heard other RNs saying that nothing gets along with NTG. But the Davis' also lists some Y-site compatabilities (amiodarone, dilitiazem, dopamine, epi, famotidine, fentanyl, lasix, mso4, theo, propofol, and many others). I'm confused, what does everyone out there do??? Thanks!

Compatibilities? Nitroglycerin infusions should have its own separate IV site thus preventing any accidental bolus' of NTG from other IVPB or IV push meds that are using the same line. No other drugs should be administered through this line if at all possible. Use a separate site for NTG and forget about compatibilities.

RNCENCCRNNREMTP · May 19, 2004

Compatibilities? Nitroglycerin infusions should have its own separate IV site thus preventing any accidental bolus' of NTG from other IVPB or IV push meds that are using the same line. No other drugs should be administered through this line if at all possible. Use a separate site for NTG and forget about compatibilities.

All boluses should be given through a separate dedicated line away from the drug infusion line. This is not just an issue with nitro but with any drug infusion. The thread was about in-line compatability, of which nitro and heparin are okay. It is a different issue altogether when you start considering the need for bolus meds through an IV with drugs already infusing. Then you absolutely need another line.

veetach · May 20, 2004

Compatibilities? Nitroglycerin infusions should have its own separate IV site thus preventing any accidental bolus' of NTG from other IVPB or IV push meds that are using the same line. No other drugs should be administered through this line if at all possible. Use a separate site for NTG and forget about compatibilities.

In a perfect world you can have a separate line for all critical drips. In my world unfortunately that isnt always a possibility.

Cassie Ryan · Sep 7, 2004

I wonder if you are getting confused with mixing in the bag and mixing at y-sites. in our IHD patients we put in two lines. Into one we put GTN, Hep and N-Acetylcysteine. We can also use Dopamine as well into the same IV line but obviously none of them can be mixed in the same bag.

Cassie

phillystudentforlife · Apr 23, 2008

Does MSO4 stand for Morphine sulfate, or magnesium sulfate? Thanks!

alkaleidi · Apr 25, 2008

I agree with those above saying that NTG IV is actually compatible with quite a lot of drugs... however... if you have someone who is sick enough to need a NTG drip, chances are they should have a 2nd large bore IV site... so you can always run whatever else in the 2nd site just to be safe until you confirm compatibility with pharmacy. I have our pharmacy's extension embedded in my brain because I am frequently calling them to confirm -- sometimes taking advantage of their knowledge is more convenient than tracking down a compatibility chart and being able to find the drugs you need on there. :-)

RunnerRN, BSN, RN · Apr 25, 2008

Does MSO4 stand for Morphine sulfate, or magnesium sulfate? Thanks!

Wow, old thread. MSO4 is morphine, MgSO4 is mag sulfate. You can see why neither are approved abbreviations now.