Contunious fluids, Incompatible antibiotics

Nurses New Nurse

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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.

Specializes in Progressive Care.
were you giving amphotericin b?

Flagyl and Cipro.

Specializes in MICU, SICU, CICU.

What was the maintenance fluid and the rate?

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.

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.

Specializes in Progressive Care.
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 ;)

Specializes in Med Surg.
Flagyl and Cipro.

What IV fluids were you giving that aren't compatible with these two? We give them all the time on my unit and haven't had compatibility issues.

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