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.
There are databases online where you can enter all of a patients meds and then print out a list of what is compatible/incompatible. One professor of ours mentioned that this is common practice in the ICU where she works; nurses run a check with each med change and tape up the results in the patient room. Probably not practical on a med-surg floor but I found that to be a very logical sounding policy.
You are doing it correctly. Pharmacist should understand the concept pretty well. Physicians don't run IVs unless they are in anesthesia, so don't expect them to be concerned about it. You can always print out your compatibility from micromedix (or whatever you use) and post it on the patient's chart. There are a lot of 'not enough data' or 'unknown' in IV compatibility but if your peers are running incompatible meds, you really should discuss it with them. Incompatible doesn't always mean precipitates. I follow what the micromedix tells me.
I just looked something up last night for compatibility to Y site vancomycin in NS and Zosyn in NS. Everyone on my floor things vanco shouldn't be y'd with anything, but it came up as compatible at the calculated levels, so 2 separate pumps and y'd together it was!
You have had several goods responses. Doctors don't know and pharmacists do. Our pharmacists are actually good about calling us or special labeling at times when they see possible problems. You are right to be concerned. Compatibility matters, and it goes beyond the drugs themselves. I gave IV Orbactiv a few days which is incompatible with NS. The line has to be flushed before and after with D5W.
We look up compatibilities all the time. If our resources don't pull up information (not tested) we talk to pharmacy to get their input and check for additional resources. I've never thought of incompatibilities as killing a patient but I've lost lines before due to crystallization. IV fluids had an additive in it and I didn't check it with an electrolyte just not thinking. Lost a lumen on a triple lumen line. I'll never do that again.
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?
we avoid that completely by running Heparin as a separate IV line on anybody who needs it. Doesn't matter whether it's Cipro or not.
Another thing that really bothers me is that very few of my colleagues are clarifying the NPO orders - if there are PO meds to be given, the order needs to specify NPO x Meds. Instead it's in the system as NPO, I'm telling the patients NPO, taking their water away from them...then I come in with pills and give them a cup of water to wash it down.
I brought this up recently, when I had a triple lumen PICC...and 4 antibiotics around the clock. Including amphotericin B (requiring IV glucose flushing prior and after) and Vanc which doesn't like to play well with others. I got weird looks when I asked if it was okay to run more than one at a time, given that some were not listed as compatible at a "y-site" on Micromedix. I understand the mechanics of a PICC, but I wanted to be clear about making sure that when they all dump out together in the vein, they would all play well together.
Interestingly the 1st Pharmacist: No don't run any together.
2nd Pharmacist: wellll. It looks like you could run some of them together, but I'll have to ask my manager in the morning (of course this happened over night).
I'm pretty sure I'm the only one who asked about compatibility with all these, so I'm sure everyone else just ran them all as they fell on the EMAR.
I brought this up recently, when I had a triple lumen PICC...and 4 antibiotics around the clock. Including amphotericin B (requiring IV glucose flushing prior and after) and Vanc which doesn't like to play well with others. I got weird looks when I asked if it was okay to run more than one at a time, given that some were not listed as compatible at a "y-site" on Micromedix. I understand the mechanics of a PICC, but I wanted to be clear about making sure that when they all dump out together in the vein, they would all play well together.
Interestingly the 1st Pharmacist: No don't run any together.
2nd Pharmacist: wellll. It looks like you could run some of them together, but I'll have to ask my manager in the morning (of course this happened over night).
I'm pretty sure I'm the only one who asked about compatibility with all these, so I'm sure everyone else just ran them all as they fell on the EMAR.
Just my experience. I wish I had some resolution.
The main purpose of a multi-lumen line is that you can run infusions separately. In the case of an open-ended PICC, the infusions do exit the different lumens right next to each other, but there is also about 1 liter of flow per minute or more passing by the tip, which immediately dilutes them negating incompatibility issues, which are most commonly acid/base incompatibilities that only require a relatively small amount of dilution to resolve.
Seems I have the opposite problem. No one where I work wants to bother to check if IV abx are compatible & assume they are not which means pts may have 3-5 sets of IV tubing when we could get by with 1 or 2. Safe but unnecessary & wasteful.
My unit is pretty good about always checking compatibility when running drips together. It is like an puzzle trying to figure out how to run everything together with the access you have, like a fresh post-op patient with multiple pumps running, 8+ channels being used. Sometimes I will print out the compatibility and tape it to the pumps for the next person.
If you wanted to try and prevent some of the Y-ing of incompatible, you could re-hang all the drips on non-vented/no ports/narcotic tubing. Of course this might frustrate your coworkers and they could still find a way to connect them into the same line but it may prevent some of it.
oceanblue52
462 Posts
There are databases online where you can enter all of a patients meds and then print out a list of what is compatible/incompatible. One professor of ours mentioned that this is common practice in the ICU where she works; nurses run a check with each med change and tape up the results in the patient room. Probably not practical on a med-surg floor but I found that to be a very logical sounding policy.