Did I imagine IV compatibility, or is it a real thing?

[Capp]

Whenever I bring up IV compatibility everyone acts like it's something that I just made up. RNs don't check compatibility, pharmacists don't check compatibility, and physicians seem to have never heard of the concept. I've had the experience before, at least once, where I mention during shift report that I started a second IV because the two drugs weren't compatible, and when I come back 12 hours later the two incompatible drugs are running through the same line. I often find that people have been running incompatible drugs together for days.

Am I being hysterical or paranoid by simply checking compatibility and not giving incompatible drugs through the same line? It seems basic to me, but I'm treated like some sort of conspiracy theorist or religious fanatic. It may seem simplistic or perhaps something of a low-bar, but my main goal in nursing is: "don't kill the patient." IV incompatibility (as I understand) can kill the patient, although that outcome is probably extremely rare. Don't do the thing that might kill the patient: what part of that logic is wrong? I'm not saying that it is likely to kill the patient or even cause an adverse effect, but I'm not going to do it anyway. I don't understand why anybody would.

[AliNajaCat]

I find it difficult to believe that you would find nobody in RN staff or pharmacy who's unfamiliar with the concept. Every phcy I ever saw had one of those big posters up on the wall, although now it's easy to find it online.

Incompatibility is more likely to result in ineffective medication rather than fatality, but we take your point.

[Flatline, BSN, RN]

Hopefully these people are aware of oral medication compatibility... IV medication compatibility is 100 times more important. Not only do you have some of the same issues as with oral but now you also have issues of precipitate formation and other issues.

Does not surprise me that a Doc would not know since they typically do not have to administer but the pharmacist should be acutely aware and be able to provide guidance.

It is unlikely anything would kill the patient but there are incompatibilities that could cause kidney damage, inactive one or both medications, reduce the efficacy, etc, etc.

Would they administer Amphotericin B with saline? Of interesting note, there are incompatibilities with types of plastic IV tubing as well. Some medications will leech the DEHP out of the tubing which is why you should use DEHP free tubing.

[Flatline, BSN, RN]

Good on you OP. Maybe you got some people thinking which will translate in better care for more patients than you can imagine.

[Capp]

Pharmacists, to their credit, are the only people who at least acknowledge the existence of IV compatibility. I said they don't check compatibility because if the MD orders two things that are incompatible they will verify them both without saying anything. But when I bring it up, they usually do confirm right away that the drugs aren't compatible.

[Double-Helix, BSN, RN]

It wouldn't be the pharmacist's job to check compatibility when verifying the drug. Unless the doctor is ordering two medications to be mixed together, they don't know if, say, the Pepcid and Lasix are going to be run in the same line or not. That's on the nurse. In addition to what Flatline said, if a crystalized precipitate forms in the tubing, you could have fatal emboli if it infuses.

Do you have an IV compatibility resource? Some medications are compatible at the Y site, others are entirely incompatible. In regard to many IV medications, there may not be data available to show whether they are compatible or not. In those cases, it's best to run them separately. However, other nurses on your floor may take the lack of data to mean they can run the meds together.

[Rose_Queen, BSN, MSN, RN]

Some of our meds come with a warning on the EMAR- the one most commonly seen in my area is Cipro. It has a warning that it isn't compatible with heparin right under the drug name, highlighted in yellow. I don't know if the same is true of other meds seen elsewhere, but maybe that's something that could be looked into?

[roser13, ASN, RN]

Your post made it sound as if you've landed in the Twilight Zone - scary:wideyed:

We used to have a ginormous IV compatibility chart on the wall beside the Pyxis. It sounds as if your floor could use one of those, plus some re-education.

[Blessings81]

I'm an LPN and yes, I've heard of it before. Nurses do it all the time. Some doctors don't know about it or don't care to know, but pharmacy SHOULD know and be aware of it at ALL times.

[AliNajaCat]

In addition to what Flatline said, if a crystalized precipitate forms in the tubing, you could have fatal emboli if it infuses.

Once again I beseech you to think about anatomy before you (not YOU you, the generic everybody-out-there you) before you think that something in an IV will cause a fatal stroke. It can't, because it won't get into the aorta except under very special and generally unlikely and uncommon circumstances.

An embolus (emboli is a plural) would have to be really, really big to be fatal when it fetches up where it inevitably will in the pulmonary capillary bed. That would be a crystal such as we used to make in the kitchen with supersaturated sugar solution for rock candy when we were Brownies.

Those leetle teeny ones you'll see when you mix, say, diazepam (Valium) with pretty much anything, while definitely not a good idea, will mix up in all the blood getting to the pulmonary artery (as a refresher, normal cardiac output is something like 4.5-6 liters-- LITERS-- per minute; what goes into the pulmonary artery is what comes out of the aorta, same amount, or where did the extra go?) and strain out in the pulmonary capillary bed. And there it will stay until it gets cleaned up by the normal mechanisms for cleaning up the strainer.

[AliNajaCat]

I'm an LPN and yes, I've heard of it before. Nurses do it all the time. Some doctors don't know about it or don't care to know, but pharmacy SHOULD know and be aware of it at ALL times.

Just because pharmacy knows about it doesn't mean that they're the ones doing the dosing. If I were a pharmacist and saw that two incompatible drugs were scheduled IV for the same time, I would be well within my rights to think that the nurse has checked for incompatibility and given them sequentially, not concurrently, or in two different lines. (I actually just did a case review of something like this. NOT pharmacy's fault. Nursing's.)

I don't want to be accused of commercial bias, but if you google "IV drug incompatibility chart" you'll find several of them. Get one for your med room, or get pharmacy to order one for every med room. Your risk manager with thank you.

[TheCommuter, BSN, RN]

Moved to the Patient Medications forum.