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Contunious fluids, Incompatible antibiotics

Posted

Specializes in Progressive Care. Has 6 years experience.

New grad here. When your patient is on continuous IV fluids and the antibiotic you need to give is incompatible or not tested with the fluids, do you usually suspend the fluids to run the antibiotic, or do you start a second IV line so the patient can get both simultaneously?

Last night I capped the fluids, flushed, ran the antibiotic, flushed, then restarted the fluids. I used the same pump, just reprogrammed it each time. I also changed the sticker on the tubing so it would be changed daily rather than every 4 days. But being that the patient was on "continuous" fluids, I'm now wondering if I should have started a second IV line. I'm also wondering if I should have used separate pumps even though they weren't running at the same time.

Usually I double check with the MD and they'll confirm if they're okay to stop or not.

Question though...you used the same tubing for both the fluids abs antibiotic?

BlueDawnRN, BSN

Specializes in Progressive Care. Has 6 years experience.

Nope I used separate tubing for everything! Thanks for the response.

SierraBravo

Has 3 years experience.

You were correct to stop the MIVF if it was not compatible with the ABX. Depending on what type of pumps you use, I would have definitely gotten a second channel instead of using just one.

HouTx, BSN, MSN, EdD

Specializes in Critical Care, Education. Has 35 years experience.

Follow your organization's policy & procedure. When in doubt, consult with a clinical pharmacist.

Thanks for the clarification!

Also if it's one antibiotic they're getting every 24 hours let's say it may be okay so just stop the fluids while the antibiotic is running. However I often get patients with continuous fluids and multiple antibiotics multiple times a day...at that point it's definitely easier to just get a second IV in.

Lennonninja, MSN, APRN, NP

Specializes in MICU - CCRN, IR, Vascular Surgery. Has 9 years experience.

It depends also on how long the antibiotics are running for. If it's a quick 30 minute merrem, stopping fluids is one thing. If it's a 4 hour zosyn, that's another. If possible, a second IV is a good idea so nothing needs to be interrupted, but on some patients that's pretty difficult.

I usually start a second IV, unless they're a hard stick or elderly with a history of CHF. Then I ask the doc if it's OK to hold the IVF while the ABX are infusing and start a second pump. I also label the tubing with the incompatibility to prevent mistakes.

BlueDawnRN, BSN

Specializes in Progressive Care. Has 6 years experience.

Thanks for your responses. I'll run it by the charge next time, and I'll also see if there's a written policy on it. And yes there's also pharmacy I can call. When in doubt I can always start a second IV if they can handle the amount of fluids. And next time I'll definitely order another pump.

The last time I called that MD at that hour, he got really angry and hung up on me (apparently this is normal for him) so I was trying to be careful about what I call for at night.

I ask a billion questions every shift being that I'm only 3 weeks off orientation, but this is something I didn't think to ask until I was thinking about it the next day. I know what I did was safe for the patient (no incompatibilities), but I started wondering whether I really stuck to the orders.

calivianya, BSN, RN

Specializes in ICU.

It depends also on how long the antibiotics are running for. If it's a quick 30 minute merrem, stopping fluids is one thing. If it's a 4 hour zosyn, that's another. If possible, a second IV is a good idea so nothing needs to be interrupted, but on some patients that's pretty difficult.

This is exactly what I was going to say. I'd say it depends on what type of unit you work on, too. How stable/unstable are your patients? If they are extremely stable, and you have a 30 minute antibiotic, there's no harm in just pausing the fluids to give an antibiotic IMO. If you are working with patients who could go bad on you, I'd recommend a second IV site even if everything is compatible, just in case. Maybe even a third.

BlueDawnRN, BSN

Specializes in Progressive Care. Has 6 years experience.

This is exactly what I was going to say. I'd say it depends on what type of unit you work on, too. How stable/unstable are your patients? If they are extremely stable, and you have a 30 minute antibiotic, there's no harm in just pausing the fluids to give an antibiotic IMO. If you are working with patients who could go bad on you, I'd recommend a second IV site even if everything is compatible, just in case. Maybe even a third.

That's really good advice, thank you. I have to think about why they're on fluids, why they're on antibiotics, how long they run, etc. We get a variety of patients on the tele floor, and this one was a fairly stable post appendectomy.

And when in doubt ask. I ask so many questions, but often come home wondering if I should have asked more.

icuRNmaggie, BSN, RN

Specializes in MICU, SICU, CICU. Has 24 years experience.

were you giving amphotericin b?

BlueDawnRN, BSN

Specializes in Progressive Care. Has 6 years experience.

were you giving amphotericin b?

Flagyl and Cipro.

icuRNmaggie, BSN, RN

Specializes in MICU, SICU, CICU. Has 24 years experience.

What was the maintenance fluid and the rate?

FurBabyMom, MSN, RN

Has 8 years experience.

Thanks for your responses. I'll run it by the charge next time, and I'll also see if there's a written policy on it. And yes there's also pharmacy I can call. When in doubt I can always start a second IV if they can handle the amount of fluids. And next time I'll definitely order another pump.

The last time I called that MD at that hour, he got really angry and hung up on me (apparently this is normal for him) so I was trying to be careful about what I call for at night.

I ask a billion questions every shift being that I'm only 3 weeks off orientation, but this is something I didn't think to ask until I was thinking about it the next day. I know what I did was safe for the patient (no incompatibilities), but I started wondering whether I really stuck to the orders.

You should be asking a billion questions every shift. :)

I would definitely check my policies to see what they say. Also, I would check with pharmacy about compatibilities whenever needed (pharmacists are your friend). Where I used to work, our online drug reference system (hospital owned), and it allowed you to enter drug names (up to a few at a time) to check for compatibility (ex you could check maintenance fluids plus antibiotics plus another drug at the same time) as opposed to looking it up through individual drug entries in the system.

As for the calling that specific MD late at night? This is an example of the type of thing that is not critical, so I can KIND of see why they might be annoyed. Knowing it's not critical, it would be easy to ask that question at a more reasonable time (ex look through your patient's orders and see if there are things like this and call about those things and other non-urgent things at say 7/8pm instead of midnight). But at the same time, it's not the first nor the last time they'll be woken up and they knew it would be this way. So. When it comes down to it, you have to do what's best for your patient. You shouldn't feel badly about it - that physician has the ability to choose how to react and that's on them. Not on you.

LargeMarge

Has 10 years experience.

Between my current and last job I have seen both done, but I think if they are regularly receiving something that is not compatible and they have decent veins a second IV would be a good idea.

BlueDawnRN, BSN

Specializes in Progressive Care. Has 6 years experience.

What was the maintenance fluid and the rate?

I'm sorry, I don't quite remember at this point. I've had a few other similar situations since then and have asked the charge nurse, who is very helpful. I also started looking up my meds before the start of my shift (if they post the assignments early enough which they often don't). This way I can work out things I'm not sure about early.

I've got big shoes to fill. There are so many distractions, never enough time and I don't want to make mistakes. I can't wait for the day when I'm not nervous about going to work. But that's another thread... ;)

I also started looking up my meds before the start of my shift (if they post the assignments early enough which they often don't). This way I can work out things I'm not sure about early.

Careful with this. This is a HIPAA violation at many institutions - you are looking at medical information of patients that aren't "yours". Unless you've swiped in already and your hospital pays you to swipe in early... which must be nice ;)