Contunious fluids, Incompatible antibiotics

[BlueDawnRN, BSN]

New grad here. When your patient is on continuous IV fluids and the antibiotic you need to give is incompatible or not tested with the fluids, do you usually suspend the fluids to run the antibiotic, or do you start a second IV line so the patient can get both simultaneously?

Last night I capped the fluids, flushed, ran the antibiotic, flushed, then restarted the fluids. I used the same pump, just reprogrammed it each time. I also changed the sticker on the tubing so it would be changed daily rather than every 4 days. But being that the patient was on "continuous" fluids, I'm now wondering if I should have started a second IV line. I'm also wondering if I should have used separate pumps even though they weren't running at the same time.

[CTnewgrad826]

Usually I double check with the MD and they'll confirm if they're okay to stop or not.

Question though...you used the same tubing for both the fluids abs antibiotic?

[BlueDawnRN, BSN]

Nope I used separate tubing for everything! Thanks for the response.

[SierraBravo]

You were correct to stop the MIVF if it was not compatible with the ABX. Depending on what type of pumps you use, I would have definitely gotten a second channel instead of using just one.

[HouTx, BSN, MSN, EdD]

Follow your organization's policy & procedure. When in doubt, consult with a clinical pharmacist.

[CTnewgrad826]

Thanks for the clarification!

Also if it's one antibiotic they're getting every 24 hours let's say it may be okay so just stop the fluids while the antibiotic is running. However I often get patients with continuous fluids and multiple antibiotics multiple times a day...at that point it's definitely easier to just get a second IV in.

[Lennonninja, MSN, APRN, NP]

It depends also on how long the antibiotics are running for. If it's a quick 30 minute merrem, stopping fluids is one thing. If it's a 4 hour zosyn, that's another. If possible, a second IV is a good idea so nothing needs to be interrupted, but on some patients that's pretty difficult.

[canigraduate]

I usually start a second IV, unless they're a hard stick or elderly with a history of CHF. Then I ask the doc if it's OK to hold the IVF while the ABX are infusing and start a second pump. I also label the tubing with the incompatibility to prevent mistakes.

[BlueDawnRN, BSN]

Thanks for your responses. I'll run it by the charge next time, and I'll also see if there's a written policy on it. And yes there's also pharmacy I can call. When in doubt I can always start a second IV if they can handle the amount of fluids. And next time I'll definitely order another pump.

The last time I called that MD at that hour, he got really angry and hung up on me (apparently this is normal for him) so I was trying to be careful about what I call for at night.

I ask a billion questions every shift being that I'm only 3 weeks off orientation, but this is something I didn't think to ask until I was thinking about it the next day. I know what I did was safe for the patient (no incompatibilities), but I started wondering whether I really stuck to the orders.

[calivianya, BSN, RN]

It depends also on how long the antibiotics are running for. If it's a quick 30 minute merrem, stopping fluids is one thing. If it's a 4 hour zosyn, that's another. If possible, a second IV is a good idea so nothing needs to be interrupted, but on some patients that's pretty difficult.

This is exactly what I was going to say. I'd say it depends on what type of unit you work on, too. How stable/unstable are your patients? If they are extremely stable, and you have a 30 minute antibiotic, there's no harm in just pausing the fluids to give an antibiotic IMO. If you are working with patients who could go bad on you, I'd recommend a second IV site even if everything is compatible, just in case. Maybe even a third.

[BlueDawnRN, BSN]

This is exactly what I was going to say. I'd say it depends on what type of unit you work on, too. How stable/unstable are your patients? If they are extremely stable, and you have a 30 minute antibiotic, there's no harm in just pausing the fluids to give an antibiotic IMO. If you are working with patients who could go bad on you, I'd recommend a second IV site even if everything is compatible, just in case. Maybe even a third.

That's really good advice, thank you. I have to think about why they're on fluids, why they're on antibiotics, how long they run, etc. We get a variety of patients on the tele floor, and this one was a fairly stable post appendectomy.

And when in doubt ask. I ask so many questions, but often come home wondering if I should have asked more.

[icuRNmaggie, BSN, RN]

were you giving amphotericin b?