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IV meds that crystallize when mixed??



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Feb 11, 2006 03:22 PM

IV meds that crystallize when mixed??

by Anjann

We are hanging and pushing IV meds this semester and our instructor always asks us beforehand if the solution and piggyback we are about to hang will interact with each other and whether or not they will crystallize when combined together in the line.

I can clearly see in my drug book what other meds are incompatible with the piggyback, but it doesn't say whether or not you can run that piggyback with a specific solution.

How would I find this info? Would it tell me in the drug book if (for example) I could not run a particular med with D5W? I have been looking through my drug book for hours trying to find an example. Is there a list or are there only a few that will crystallize when mixed with a particular solution? I have already been to the Infusion nurses Association website, but could not find any kind of list.

Pardon me if this is a dumb question, but I want to be on top of it when I get to clinical again next Saturday.

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9 Comments
No. 1
from RoxanRN2003
Old Feb 11, 2006, 04:23 PM

Default Re: IV meds that crystallize when mixed??
Originally Posted by strugglinginVA
We are hanging and pushing IV meds this semester and our instructor always asks us beforehand if the solution and piggyback we are about to hang will interact with each other and whether or not they will crystallize when combined together in the line.

I can clearly see in my drug book what other meds are incompatible with the piggyback, but it doesn't say whether or not you can run that piggyback with a specific solution.

How would I find this info? Would it tell me in the drug book if (for example) I could not run a particular med with D5W? I have been looking through my drug book for hours trying to find an example. Is there a list or are there only a few that will crystallize when mixed with a particular solution? I have already been to the Infusion nurses Association website, but could not find any kind of list.

Pardon me if this is a dumb question, but I want to be on top of it when I get to clinical again next Saturday.
There is not such thing as a dumb question.

Are you looking things up in an IV drug book (mine is by Mosby - spiral bound) or a regular drug book? You need the IV book (might be in a PDR - dunno). Some places to look include what sulutions can the drug be mixed in (therefore, compatible) and the incompatible section. All else fails, call the pharmacy and ask 'Is X drug compatible with Y solutions for piggyback or otherwise?' They are access to all kinds of manufacturer information.

Good luck.
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No. 2
from PICC ACE
Old Feb 15, 2006, 07:58 PM

Default Re: IV meds that crystallize when mixed??
Your drug book should tell you if there's an incompatibilty with dextrose. There are a few--Ertapenam comes to mind and I know there's a few others,so you'd need a NS system to run it. But will it actually crystallize in the line?? Incompatible is incompatible--does your instructor insist on the specifics? I'd hope not. Another incompatiblity to watch for with pushes and piggybacks is Heparin. If the facility you're at locks periph IV's with Heparin or if you're going into a central line that is locked with Heparin,the line needs to be properly flushed beforehand.
Good luck. By the way,what kind of infernal nursing school has clinicals on Saturday???
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No. 3
from Anjann
Old May 27, 2006, 03:28 PM

Default Re: IV meds that crystallize when mixed??
Thanks! I think she was just trying to scare us because she stopped asking after awhile,and no student ever had an incompatibility. You were right about the hep locks and central lines, but we always flush.

I guess as hard as this school has been for me, the saturday clinical was just another gate to jump, but even the nurses we were paired with at the hospital cracked jokes about why we were there on a weekend. Oh well, at least we got more time with the nurses since they didn't have to wait on the doctors!
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No. 4
from ralphrepo
Old May 27, 2006, 09:07 PM

Default Re: IV meds that crystallize when mixed??
Diphenylhydantoin (Dilantin) cannot be given in any solution that contains sugar as it will immediately crystalize. That is perhaps the most well known one. There are others that are very specific that I won't bother to get into.

Ralph
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No. 5
from Anjann
Old May 28, 2006, 12:20 AM

Default Re: IV meds that crystallize when mixed??
awesome! that's a good start. thanks alot!
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No. 6
from LIZPICURN
Old May 28, 2006, 02:07 AM

Default Re: IV meds that crystallize when mixed??
I have noticed usually each hospital has a printed sheet for RN's stating what is considered compatible or noncombatible meds during an IV infusion for that particular hospital (they can slightly vary). My number one resource is the pharmacy. When in doubt I always call them.
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No. 7
from ZASHAGALKA
Old May 28, 2006, 02:12 AM

Default Re: IV meds that crystallize when mixed??
1. Most units have a 'grid' that lists medicines across and down with a chart that shows 'C' for compatible, 'X' for incompatible, or nothing if it is unknown.

2. Our computer system includes 'micromedex' which is a healthcare database that includes a program that determines compatibility. Input one or more drugs, and it will tell you data about the compatibility of the drugs to each other and to the different IV solutions.

3. Pharmacy routinely handles these kinds of questions. If you are unsure, call pharmacy. They have books and books on the subject.

Famous incompatibilities: Lasix and Cardizem, Solumedrol and Cephalosporins, Bicarb and lots of stuff. . .

If in doubt, use the resources both ON the unit, and available by computer and phone.

The next time you are on a unit, ask someone about their 'IV compatibility chart'. It's usually a poster and most units have it taped up somewhere.

~faith,
Timothy.
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No. 8
from Dublin37
Old Feb 21, 2009, 11:04 PM

Default Re: IV meds that crystallize when mixed??
Originally Posted by PICC ACE View Post
Good luck. By the way,what kind of infernal nursing school has clinicals on Saturday???
All the Jr. College ADN programs here in CA do Saturdays. There are sooo many universities/colleges trying to get their students in for clinicals, that they have to split them up btwn weekday and weekend. I even worked one Sunday. That was fun, it was sooo quiet. And besides, we will work a lot of Saturdays once we get that glorious RN right?
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No. 9
from iluvivt
Old Feb 22, 2009, 09:22 PM

Default Re: IV meds that crystallize when mixed??
I still think that Bettyy Gaharts IV medications is the best. It comes out every year and you can quickly look up anything without being put on hold by a pharmacist. Please remember that you can have a physical incombatability and a chemical incombatability. A physical incombatability usually produces a precipitate in the IV system...you may or may not see this as it may occur anywhere in the system (as in a CVC). A chemical incompatability will render one or both of the medications ineffective or not as effective or change the properties. So be aware that just b/c you do not SEE something that does not mean all is OK. Some medications even stick to IV tubing or devices and hours later you hang a medication and look down....and see a precipitate, Hang bicarb in a volutrol and then add something hours later that is incompatable and you will see. A good rule of thumb is that medications and drugs that are very basic or acidic tend to be problematic in this regard....so always look up if you do not know the compatabilities.
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