Compatibilities of IV piggybacks

Nurses General Nursing

Published

Specializes in Pulmonary med/surg/telemetry.

i'm in my last semester of nursing school and i'm still a bit unsure about iv piggybacks even though i've asked questions from all the nurses i possibly can. it seems that i get different answers from everyone and i can't seem to locate a clear cut answer in any of my textbooks. i just want to make sure that i'm doing things the right way and have at least a solid understanding before i graduate.

i know how to look up which continuous iv solutions are compatible with which medications, but what i'm unclear about is how to find out which medications are compatible with each other. for instance, most of my patients are on multiple iv piggybacks throughout the day. ns will be running with a piggyback of vanco, then merrem, and later on flagyl. i see most nurses just backprime the "old" line with ns for a few seconds, unattach the old piggyback bag, and then reattach the new bag and run it. this just doesn't seem completely safe to me. how am i to know that (just as an example) merrem and flagyl are compatible, and if they're not is this quick flushing of the line adequate to clear it all? if not, what is a better practice? is it better to use a different line for each antibiotic and just hook up that line whenever it is changed? or is this unnecessary and extra work?

i guess i'm asking what the right way is to do this. i know there can be multiple ways to do it the "right" way and i just want to make sure that i'm not doing something in a way that is inadvertently cutting corners. i've heard people say that you can call pharmacy to check about the medications but i'd like to know if there's a place i can look this up on my own rather than calling pharmacy each time, which seems almost impossible taking into consideration how many times in a shift this has to be done.

anyway, sorry for being so wordy. thanks in advance for any help you can give me.

Up Vote Up Vote ×
Specializes in LTC, med/surg, hospice.

In the IV drug guide under each medicine it will list compatibility. If something is incompatible with the primary fluids and antibiotic, I will run it in straight and flush in between. We have the drug guide on every unit.

I don't know many off the top of my head but bi-carb doesn't like most things and I've come behind nurses piggybacking antibiotics off of it when they should not.

Up Vote Up Vote ×
Specializes in Cardiac, ER.

I'm not sure I understand what you are asking,...any drug book list compatibility. If you are running NS, then need to piggy back say 5 different meds,...if you hang them back to back et flush in between than the compatibility isn't an issue. Run the 1st PB,.flush (allow the NS to run for a few minutes) then hang the next one. Is this what you're asking?

Up Vote Up Vote ×
Specializes in NeuroICU/SICU/MICU.

If your hospital subscribes to Micromedex, you can look up any drug to see if it's compatible with any other IV fluid or drug. It's a website that should be available through the hospital's internet. You just click the "IV compatibility" tab at the top of the page. Good luck!

Up Vote Up Vote ×
Specializes in ORTHOPAEDICS-CERTIFIED SINCE 89.

Instead of asking coworkers at least ask a pharmacist. When in doubt, DON'T is the best answer. We had a chart that listed the most frequently used drugs, but just to be safe usually I would run something straight rather than use a questionable line even if it meant starting another IV site.

Up Vote Up Vote ×
Specializes in Infusion Nursing, Home Health Infusion.

Yes this can be confusing.

1 First of all look at what is in your primary bag...anything that you give as a secondary ( piggybacked in above the pump) MUST be compatable with what is in the primary. IF it is NOT then you can not hang it as a secondary...that is the first key point. If it is not that you you either give it in a seperate lumen...establish another access or give it at the T ext directly at the site ( No this is not considered mixing if given directly at the site.)

2. If you are giving multiple secondaries they must all be compatable with the primary but DO NOT have to be compatable with each other as long as you backprime correctly.....yes it is much safer to back-prime than to disconnect and have multiple secondaries hanging b/c the constant connection and disconnection increases entry into the system and thus infection risk. If you connect and disconnect secondaries then that tubing needs to be changed every 24 hrs per INS b/c essentially it a primary intermittent at that point...get it???

Up Vote Up Vote ×
Specializes in Pulmonary med/surg/telemetry.

Thank you all so much for your help.

RNMeg-Yes, my hospital does have Micromedex. I use it for information on the drugs themselves, but I've never realized there was an IV compatibility tab. I will definitely be looking for that!

P_RN-I agree about not going by what other co-workers tell me. I've realized that people have many ways of doing things and they aren't always considered the "correct" way. Since I'm just now forming my own ways of doing things I want to make sure that I'm not starting off by doing them incorrectly and I love to have references to back up my "why" of how to do them. Thanks.

iluvivt-Thank you so much for the information. Yes, the rationale that you gave makes perfect sense.

Up Vote Up Vote ×
If your hospital subscribes to Micromedex, you can look up any drug to see if it's compatible with any other IV fluid or drug. It's a website that should be available through the hospital's internet. You just click the "IV compatibility" tab at the top of the page. Good luck!

This is a great program for determining compatibility and lots of times I would trust it over what the pharmacist says. There have been times when I have called pharmacy and they really didn't know.

Up Vote Up Vote ×
Specializes in Critical Care.
If your hospital subscribes to Micromedex, you can look up any drug to see if it's compatible with any other IV fluid or drug. It's a website that should be available through the hospital's internet. You just click the "IV compatibility" tab at the top of the page. Good luck!

My hospital has Micromedex, its a great tool. Also, if you're unsure, just hang a new line. It isn't like a new secondary line is going to break the bank.

Up Vote Up Vote ×
Specializes in Anesthesia, CTICU.
This is a great program for determining compatibility and lots of times I would trust it over what the pharmacist says. There have been times when I have called pharmacy and they really didn't know.

Whenever I call pharmacy, they log into the micromedex (I can hear them typing) and clicking on each drug I need to run as I tell them over the phone. Much easier to do it myself!

I've also found it a good idea to print out the micromedex screen and tape/rubberband it onto the front of the bedside chart as a clear reference for this patient's drips. That way, at shift change, when the oncoming nurse (politely) questions compatibility of drips, they can see you've done you're homework and there is no room for confusion or second-guessing. lol :rolleyes:

Up Vote Up Vote ×

If I have multiple secondaries, each has it's own line and I connect/disconnect into the primary. Yes there is a slight risk of infection but I clean each piece with alcohol before connecting and cap the ones that aren't running at the moment. If the drugs aren't compatible with the primary, they get their own primary line, I stop the IVFs, run the drug, then reconnect the fluids. Always err on the side of caution when it comes to compatability!

Up Vote Up Vote ×

I agree with RN-Cardiac.

Also, someone taught me to program the piggyback infusion so the total VTBI is 5 ml over the amount in the secondary bag. That way, all the piggyback infusion will run in, including what's in the drip chamber. Also, if the patient is heplocked in betwen piggyback infusions, set the "Primary" fluid to run so the VTBI is set at only 30 ml. That will flush the line and you'll be ready for the next piggyback infusion.

Up Vote Up Vote ×
+ Add a Comment