IM multiple med compatibility & technique

  1. 0
    Hi everyone,

    An order yesterday read to give Toradol 30mg and Morphine 10mg IM to a pt in narcotic withdrawal. He was a tough pt so I consulted the Charge RN on how to best admin these meds.

    She told me that they were not compatible meds so I should give them in separate syringes, but tape the syringes together and give the two shots simultaneously, by aspirating and administering the first syringe and then the second.

    I had a few concerns with that suggestion which I kept to myself, but basically I didn't feel comfortable with that technique at all, not to mention that it would be a dose = 2 mL which can't go into the deltoid, and if they were not compatible then wouldn't they contact each other in the muscle and crystallize?

    I then checked the compatibility of these meds in our regional pharmacy information and found that they were "Y-site IV Compatible". So basically you could run them together with N/S.

    My questions:
    1) Has anyone given IM injections the way this nurse described?
    2) If 2 medications are compatible through IV, are they also compatible to mix together for an IM injection?

    Thank you so much for your help!
  2. 9 Comments so far...

  3. 3
    Wow, tape them together? I have never seen that - but I am curious if others do that. No, I just usually give one, then the other if they are not compatible. If it is a particularly difficult pt to do this (like a kiddo, or a combative pt, I ask another nurse to do one side while I do the other).
    As for finding out if you can put them in the same syringe? Don't forget about calling pharmacy, they can tell you specifically if you can give them together IM or not.
    flyingchange, DSkelton711, and netglow like this.
  4. 2
    Two meds that are Y site compatible may not necessarily be compatible mixed in an IM syringe.

    When meds are run together at a Y site, there is actually very little surface area of mixture between the two. This minimal amount of contact and mixing may allow 2 meds that really aren't terribly compatible to be given together because there is little opportunity for the meds to react and precipitate, for example.

    Mixing the same 2 meds in a syringe is a different matter, especially in a 3 cc syringe where there is plenty of space for meds to mix, interact, react and possibly precipitate. (You indicated that the volume of the injection would total 2 ccs, so I'm assuming that you would use a 3 cc syringe to combine them.)

    As for taping multiple syringes together, that just sounds dangerous. Too much room for error...missing and not injecting both needles, one or the other needle not being inserted deep enough, the second needle becoming dislodged if the patient flinches or jerks when the first med is injected, etc...You have to consider your own safety as well as the patient's comfort.

    I agree with the previous poster. Either explain the unfortunate need for separate injections, or have a second nurse inject at the same time.
    flyingchange and Ruthfarmer like this.
  5. 1
    Two syringes taped together sounds like a recipe for disaster, either for the patient or for the nurse - particularly with regard to increased risk for needle sticks.

    I've never had trouble giving IM injections, even to combative patients.
    flyingchange likes this.
  6. 1
    Always, always, always look up your meds! Toradol doesn't play well with anything.
    flyingchange likes this.
  7. 1
    Even if you were to do that - (both syringes at once) its too much for a deltoid you'd have to go to ventralgluteal and go that route.
    flyingchange likes this.
  8. 1
    Totally anecdotal but if I picture having to explain to someone that I taped two syringes together (Joint Commision, a jury, etc) does not sit well with me.

    Combative pt's can be difficult to give IM's to when you are trying to avoid getting stuck! Never that fun.
    flyingchange likes this.
  9. 0
    Quote from FancypantsRN
    Don't forget about calling pharmacy, they can tell you specifically if you can give them together IM or not.
    Quote from RN-Cardiac
    Always, always, always look up your meds! Toradol doesn't play well with anything.
    Quote from Jolie
    Two meds that are Y site compatible may not necessarily be compatible mixed in an IM syringe.

    When meds are run together at a Y site, there is actually very little surface area of mixture between the two. This minimal amount of contact and mixing may allow 2 meds that really aren't terribly compatible to be given together because there is little opportunity for the meds to react and precipitate, for example.

    Mixing the same 2 meds in a syringe is a different matter, especially in a 3 cc syringe where there is plenty of space for meds to mix, interact, react and possibly precipitate. (You indicated that the volume of the injection would total 2 ccs, so I'm assuming that you would use a 3 cc syringe to combine them.)
    Thanks, I was trying to do this but I wasn't sure where to look. I am wondering if there is an easier way to look up syringe compatibility other than calling pharmacy every time I want to avoid giving 2 shots? Perhaps an online look up tool? I was hoping it was as easy as the y-site compatibility but I definitely understand about the surface area and potential for reaction. I'm at a loss...

    Quote from ♪♫ in my ♥
    Two syringes taped together sounds like a recipe for disaster, either for the patient or for the nurse - particularly with regard to increased risk for needle sticks.
    It was the weirdest suggestion... This patient wasn't even combative. He just wanted his meds and was trashing the room while he was waiting, but he was fine for the injection. It seemed like the RN just normally did this if she had to give 2 separate injections.

    Quote from deemalt
    Totally anecdotal but if I picture having to explain to someone that I taped two syringes together (Joint Commision, a jury, etc) does not sit well with me.
    Ugh, exactly. Headline: Student nurse gets eye poked out while trying to MacGyver 2 syringes together. Patient says "I would have just had 2 shots, no big deal"
  10. 3
    There are times when neither pharmacy, not LexiComp, nor King's Guide or the blessed manufacturers can help you.
    Not because they don't want to but simply because there is "insufficient data".

    Here's a humble ED "burlak" 's perspective:

    * When in doubt - as many shots ordered, that many different sites.
    * If this is going to be an issue - call security, restrain pt. and administer meds.

    All this talk of "taping syringes" and what not is just asking for trouble.
    JMO.

    cheers,
  11. 0
    When my kids were little and getting their vaccinations my doctor would not tape the two together but did give them at the same time, so they only felt the one poke.


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