IV Compatibility

lilbeans · Mar 30, 2012

I just finished my first week of orientation in the ICU. It is going very well, I am just a little confused about compatibility. The patient I was caring for was on several different gtts, all running into the same thing. (I can't think of the name of it, but it has multiple openings to arrange all the lines running into the patient.)
Dopamine
Levophed
Insulin
Epi
Bumex
Versed
Fentanyl
D5.45
So technically all of this was running in together, as it was all going into the patient's cordis. I asked my preceptor if it would be inappropriate to push my other IV meds into the main line and she said it was fine. Is this true?

I work in Pediatrics and I am just now being trained into the Pediatric ICU (we are one unit and must be trained into both areas). I am not familiar with some of the medications but I do know in the PICU that we usually have compatibility charts printed out with the medications and drips the patients are getting. We also have a program on the computers to check the compatibility. If the line (I am assuming this is a central line of some sort) has multiple lumens, then not all the medications are mixing together. I would figure out which drip is compatible with the med i am administering. Otherwise pause one of the drips and flush, give the med and flush, then restart the drip. If all else fails, see if you can get a PIV.

ckh23, BSN, RN · Mar 30, 2012

I'm confused. Where all of these running through one port or was this a codris with multiple lumens? The short anser is yes you can push the meds if you have an open port or if it is just IVF going through. I wouldn't be pushing it through a line that has these meds running through it because you will be sending those meds with it and it doesn't take much epi or levo to shoot up a patient's BP. Most if not all of these meds can be infused through a single port, we use Micromedex and it has a feature that will allow you to list drugs and see what is compatible and what is not.

Esme12, ASN, BSN, RN · Mar 30, 2012

Were they ALL infusing into the same port of the cordis introducer? You need to go to your preceptor and specifically ask her this question, and to show you. I have seen these channel pumps. Usually, and I emphasize the usually, what ends up happening after the pump the groupings end up terminating in different ports.

For example......the Dopa, Levo, Insulin, bumex, and epi in one Chanel that will go to one port, lets say the cordis introducer. The Versed, Fentanyl, (bumex can be infused here as well) and D5.45 together into another port, the CVP port of the Swan. Boluses and such can be given here without compatibility issues or reaction by the patient and the patient's vitals. The bumex, versed, and fentanyl can be briefly interrupted, flushed, and restarted to give an incompatible med without untoward reaction to the patient if necessary.

The other meds should not be interrupted except for necessary tubing changes or changes in vitals.

You need to specifically follow the lines directly to which port that they are infusing. Now, if they are going into the same port.......it would be unusual, but technically they are all compatible to be run together (I believe on a brief initial check).

I personally would not give bolus/push meds here as I would not bolus the patient with Dopa, Levo, or Epi.....nor would I interrupt them to flush and then give a med....as both scenarios can have a deleterious effect on the patient. So follow your facilities policy and procedure.

Not the definitive answer you are looking for but I hope it helps. :paw:

daydreaming · Apr 11, 2012

Off the top of my head.....

generally all pressors are compatable

typically sedation is compatble (ie fentanyl and versed), but if you give a bolus, everything gets a bolus

for insulin, generally i run it alone, just in case for boluses, and same applies, if you bolus, then you bolus everything

i would think in this case, that the pressors would be running thru the cordis, and everything else peripherally.... versed/fentanyl can run peripherally, bumex peripherally, insulin, d5 periphally.

while this was going on, they should be establishing additional access. what other access did this patient have? picc, tlc, portacath, peripherals, etc.? usually cordis are placed for high volume quick, ie gi bleeds.

lastly, why was this patient on d5 and insulin together?

j

I just finished my first week of orientation in the ICU. It is going very well, I am just a little confused about compatibility. The patient I was caring for was on several different gtts, all running into the same thing. (I can't think of the name of it, but it has multiple openings to arrange all the lines running into the patient.)
Dopamine
Levophed
Insulin
Epi
Bumex
Versed
Fentanyl
D5.45
So technically all of this was running in together, as it was all going into the patient's cordis. I asked my preceptor if it would be inappropriate to push my other IV meds into the main line and she said it was fine. Is this true?

esie · Apr 12, 2012

It is standard practice here in Oz that 99% of ICU patients have an IJ, sub-clavian or femoral multi-lumen central line inserted, or a PICC line if they are a long term patient requiring fewer infusions. The central line would have either three or four lumens. The distal lumen is connected to CVP monitoring, and can be used for IV injections or as an extra line as required. Another lumen is devoted to inotropes. The final lumen (in a triple lumen) has a "traffic light" (multi port attachment) attached, into which the maintenance fluid, fentanyl, propofol, midazolam, precedex, potassium, insulin, frusemide, etc etc is infused. If I am lucky enough to have a quad lumen line, the fourth line will be for a drug that must generally run alone, such as TPN with insulin piggybacked), GTN, heparin, etc. Our bible is the Australian Injectable Drugs Handbook, which details all IV drugs available in Australia, with each drug entry detailing availability, generic/trade names, preparation, administration, stability, compatibility/incompatibility data, and special notes. If I am in doubt about compability, I consult the bible, and then juggle lumens as necessary (and if desperate, insert a peripheral IV).

rgroyer1RNBSN, BSN, RN · May 2, 2012

Be safe just start another piv, heplock it, do pushes through it. And why D5 and insulin togather, I think doc needs to retake that day of pharm.

hodgieRN · May 4, 2012

It's not unusual for pts to be on D5 and an insulin gtt. If not on TPN or tube feeding, dextrose is needed for metabolism. Plus, D5 should be up on a pt with an insulin gtt once the blood sugar is less than 200 to prevent hypoglycemia, especially in pts with HHNK. With HHNK, just a little bit of insulin can make there BG drop significantly, so D5 would help hypoglycemia :)

But one thing though, Bumex is not compatible with versed. Here's the thing with a Cordis. It's a very large, single lumen line. You use it to dump in large amounts of fluid in a short time. When you are dealing with drugs that are incompatable, you may not recognize any precipitate particles b/c it is so diluted. You don't really see it. For example, if you take 2 drugs that are incompatible but mixed in a liter of fluid (for argument's sake), you won't find it. With all those gtts and a large lumen, it could have been missed. It's not good to just look for a white cloud in the line. Plus, any diprivan will for sure mask it. Probably good for bumex to have a dedicated line.

It's good to print IV compatibility from the hospitals online resource. If you want to push a med, you have to check on the compatibility. After a while, you memorize which drugs are ok to mix. When in doubt, throw in a peripheral line, twin cath IV, or take them to radiology and get the cordis exchanged with a multi-lumen central line.

jodyangel, RN · Jun 10, 2019

Is D545 and an insulin gtt ok to run on the same line? What will it do if it was run together?

Pheebz777, BSN, RN · Jul 5, 2019

On ‎6‎/‎10‎/‎2019 at 1:04 PM, jodyangel said:
Is D545 and an insulin gtt ok to run on the same line? What will it do if it was run together?

It will help transport the glucose into the cell for energy.

jodyangel, RN · Jul 5, 2019

Ive been taught that ONLY 0.9 NS is compatible with Insulin....so if they need D545 patient has to have 2 IVs infusing...

jodyangel, RN · Jul 6, 2019

On 5/3/2012 at 9:26 PM, hodgieRN said:
It's not unusual for pts to be on D5 and an insulin gtt. If not on TPN or tube feeding, dextrose is needed for metabolism. Plus, D5 should be up on a pt with an insulin gtt once the blood sugar is less than 200 to prevent hypoglycemia, especially in pts with HHNK. With HHNK, just a little bit of insulin can make there BG drop significantly, so D5 would help hypoglycemia :)
But one thing though, Bumex is not compatible with versed. Here's the thing with a Cordis. It's a very large, single lumen line. You use it to dump in large amounts of fluid in a short time. When you are dealing with drugs that are incompatable, you may not recognize any precipitate particles b/c it is so diluted. You don't really see it. For example, if you take 2 drugs that are incompatible but mixed in a liter of fluid (for argument's sake), you won't find it. With all those gtts and a large lumen, it could have been missed. It's not good to just look for a white cloud in the line. Plus, any diprivan will for sure mask it. Probably good for bumex to have a dedicated line.
It's good to print IV compatibility from the hospitals online resource. If you want to push a med, you have to check on the compatibility. After a while, you memorize which drugs are ok to mix. When in doubt, throw in a peripheral line, twin cath IV, or take them to radiology and get the cordis exchanged with a multi-lumen central line.

This is a PIV.