Need some solid answers

it's unusual that a level like that arises to something serious, but i don't thing docs think of it. perhaps it's because no one is usually on nipride longer that a few days.. it is at the discretion of the RN to add a level when sending labs, no? you may be the hero in the end...! there are some things that once you learn you will never forget.. simple or not.

I don't know if your pharmacy will do this or not, but this is another suggestion that we utilize. Our pharmacy is great, and we have sick, sick, sick pts a lot of the time in our SICU since we are trauma, neurosurgery, and a bariatric center (you all know what happens with a leak-youch)...anyway, our pharmacists will make a grid of all the drips, prn's, and scheduled ABX and replacement as to what is compatible or not...even though you think all pressors can go togehter...They CAN'T. Levo and neo aren't the greatest together because one has to be placed in D5 and the other in NS....I can't remember which, but the pharmacy always helps me out with this also.

Jen

First off you are doing better than a ton of new nurses by asking questions and researching information.

I oriented lots of new grads and answered allot of questions since I was charge a fair amount of time. I tried to tell people to use their resources the hospital allows has pharmacist on duty who are there to help you if you call and ask. Never mix meds based on use i.e. pressers they can be ran in the same line because of chemical properties. A good example is diprivin which tons of nurse think has to have a dedicated port just for it. In reality you can run many drugs together such as

DIPRIVIN COMPATIBILITY

compatible with the following solutions in the IV line: D5W, D5½S, D5LR, LR
compatible via Y-site with aminophylline, calcium gluconate, cyclosporine, dobutamine, dopamine, epinephrine, fentanyl, heparin, hydrocortisone, insulin regular, ketamine, labetalol, lidocaine, magnesium sulphate, midazolam, milrinone, morphine, nitroglycerin, nitroprusside, norepinephrine, potassium chloride, sodium bicarbonate, sufentanil

source for people who want it
http://www.vhpharmsci.com/PDTM/Monographs/propofol.htm

A good idea for mg and kcl have them mixed into one bag since the both run over a long period of time

It looks like you didn't get to finish your thought? Happens to me all the time!!!!

If you are saying that it's okay for propofol to run with other drips, I want to disagree and here's why:

http://www.ncbi.nlm.nih.gov/entrez/q...&dopt=Abstract

This is something that I've personally experienced on several occassions. Our pharmacy provides us with a stopcock designed specifically for administering propofol. We ALWAYS run this wonderful drug the through a designated line. By allowing it to run with other drips there is the distinct possibility, I have seen it happen, that it will cause a leak at the stopcocks of other drugs.

http://www.ncbi.nlm.nih.gov/entrez/q...&dopt=Abstract

I agree that a chart/table listing all the drugs on both X and Y axis and with green/red dots as to what is compatible with what should be in every critical care unit. We had a great one in my last unit - if I still worked there, I would send it to you! Maybe you can take that on as a project and come up with one if your unit doesnt have one already? We had it laminated and stuck to the desk in each room!

I always label my tubing at the injection ports and label my pumps as well. Micromedex is usually available in every ICU and it has a compatablitly section which is wonderfull. I run my mag and K+ together. I will run my TPN with insulin, as this keeps other lines open for me. I routinely run my propofol with other drips that it is documented compatable with. I had not seen or heard the above research about the cracks. Also, as tubing is changed Q12 hours on propofol infusions, that would include the stopcock. Does that factor into the leaks? One thing to take note of as well, is that even if a drug is compatible in a certain concentration, it may not be compatable at higher concentrations. One exammple is Lasix and Dopamine. We frequently highly concentrate dopamine and lasix in our renal patients, and it WILL precipitate.

I don't know if they've research the frequency of changing the stopcocks. I do know that we have received patients from the OR with stopcocks already leaking.

Good question.

I have been spending the last several months of my senior practicum in a CT & SICU. There is a question that keeps bugging me about multiple drips and I just don't seem to understand the answers I get from people. My biggest fear is bolusing a pressor or opioid or something that could have dangerous results--I am also concerned about it taking too long for a person to actually get whatever medication is going at a slow rate if I have it plugged in behind something else.

If you are running different drips (that are compatible) but they are running at different rates, what is the best way to do this?

I have heard people say they administering "Drug X" at 2 ml/hr and pushing it in with ? amount of NS. Wouldn't this bolus the drug if the NS is running faster? I would be afraid to do that.

Or if a person has fluids going at 100 ml/hr and yet has several other drugs going at much slower rates, what is the best way to do this?

One example, I put the fluids in one central line port, plugged propofol into that line, then plugged something else into the propofol. Wouldn't the drug plugged into the propofol, say going at 5 ml/hr take forever to actually get into the patient?

And I've heard people say that epi has to be run all by itself, is this true?

Thank you in advance for your replies. This issue has me all confused.

I've never heard the Mg before K thing either. Can someone explain? Why would this aggravate a hypo-k situation? Thanks in advance