Compatibility

[jewel_rn]

I work in Medsurg floor & the ER brought up a patient who came in with PICC line for her epoprostenol for her pul. hypertension. From report, she was hard stick and the ER doctor gave an ok to use PICC line. When patient was brought up, I noticed that they have y-sited her epoprostenol and zosyn. I consulted with the charge nurse and she claims as long the ER doctor approved the use of the PICC line, it's ok. There are no research that support compability/interactions of the two. Can this be a write up or incident report?

[KelRN215, BSN, RN]

Did you consult with the Pharmacy and see what they say?

I recently had a patient who needed to go home on nafcillin and ceftriaxone and my Pharmacist said there was no data (based on the resources available to her) but the hospital I liaise at's formulary included 5 studies that showed y site compatibility.

I disagree with the charge RN who said it was fine as long as the ER MD said it was but I'd consult the Pharmacy before jumping to an incident report. There may be data they have access to that you don't.

[chare]

Deleted.

[JKL33]

I work in Medsurg floor & the ER brought up a patient who came in with PICC line for her epoprostenol for her pul. hypertension. From report, she was hard stick and the ER doctor gave an ok to use PICC line. When patient was brought up, I noticed that they have y-sited her epoprostenol and zosyn. I consulted with the charge nurse and she claims as long the ER doctor approved the use of the PICC line, it's ok. There are no research that support compability/interactions of the two. Can this be a write up or incident report?

Sorry, but there is a problem when that is your question, out of at least a few others you could've asked.

"Where can I find out if this practice is okay to continue?"

"How can I check to make sure the PICC is working correctly?"

"Is there any other way I can accomplish this besides the method used by ER?"

Etc.

"Can this be a write up or incident report?" = WRONG QUESTION.

[Atl-Murse]

Do you believe there is a comparability issue or you just eager to throw someone under the bus?

[Guest374845]

Well, if this had been my patient I'd have started by slowing my roll. The pt obviously wasn't stroking out from a bejillion little precipitate emboli, so I'd conclude that there's chemical stability. And if their PAH symptoms were controlled I'd make another logical leap that the potency of the flolan wasn't effected (or by much).

I'd then either rig up a dilutional stopcock manifold (ala every other ICU drip that isn't technically compatible), or god forbid start a PIV, write my progress note without starting a senseless charting war, and finally move TF on.

[MikeyT-c-IV]

I'm slightly confused as there seems to be two different issues. The doctor said that it was okay to use the PICC, correct? I'm assuming a chest xray or another technology was used to confirm proper positioning of the PICC.

The two drugs were infusing in the same port of the PICC? Was this a multi-lumen PICC? If so, and you are concerned about compatibility, just run the drugs in two separate lumens.

Nice reply Euro_Sepsis... agreed.

[blondy2061h, MSN, RN]

We've had patients have multiple forms of central access if they need incompatible meds and peripheral access isn't doable, ie, bilateral PICCs.

[MikeyT-c-IV]

We've had patients have multiple forms of central access if they need incompatible meds and peripheral access isn't doable, ie, bilateral PICCs.

I don't understand. Incompatible meds may be given through different lumens of a central line.

[iluvivt, BSN, RN]

Confirm for yourself that PICC tip is central at CAJ or low SVC optimally and then run the drip in one lumen of the PICC and use other for Zosyn and other meds.My research indicates is is not compatible and a precipitate may form.You must also know that there is therapeutic and chemical incompatibility in addition to physical.In other words you may not see a precipitate if a drug drug incompatibility exists and falls in one of those categories.Just because an ED MD says its ok to use....do not blindly trust them unless you see the picc tip verification for yourself..either the CXR or report of use of a tip confirmation system (TCS).If a TCS was used make sure the documented amount externally visible has not changed and the patient has no s/sx of secondary malposition and document those finding and your assessment before using the PICC.If MD states PICC is ok to use and it's not that will save you from any liability so check for yourself on ANY CVAD.

[blondy2061h, MSN, RN]

I don't understand. Incompatible meds may be given through different lumens of a central line.

I'm assuming this is a single lumen picc given the concern. The OP says that they were y-sited, not running on a separate lumen.