Discovering incompatible IVPB's with primary lines - anyone else notice this a lot?

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Tonight has been about the 3rd time that I've discovered an incompatible IVPB hanging with a primary IVF (I'm a new nurse). For example, tonight (during my primary assessment, after coming on shift) I had someone with KCL 20 in 1000 ml and a IVPB running and already DONE (with some green leftover in the tubing.) I was curious and I called pharmacy to ask them if they were compatible -- they said to run them separate. Then I said it was already ran in and they were like uhh, just watch the patient. This seems to have happened several times though. Other previous times I'll go to hang the PB and I'll notice that it had already been given, like 24 hours ago, and still hanging on the primary line. I'll call to see if they're compatible with pharmacy and they tell me it isn't -- well, it appears as though whoever had that person before ran it anyways ???? I don't understand?? Do some people just NOT have a reaction to the mixture of certain things that are 'incompatible' ??

Specializes in cardiac.

Our policy is that nothing is to hang with TPN/lipids, ever. If something else needs to be given then the pt gets a new IV site.

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Specializes in LTC, Med/Surg, Peds, ICU, Tele.
By the drugs being incompatible I have always took it to mean the two meds wouldn't mix and you would end up with precipitate;not that the patient would actually have a reaction to them being run together.If the meds were given 24 hours previous and you still had a working IV line then they were not incompatible. I have found that pharmacy will often advise running things seperate if they are unsure-there are just too many meds and too many possible combos to have literature supporting all of them-thus, they will always tell you to err on the side of caution and seperate.

I was told by a pharmacist at my last place of employment that when a nurse calls to ask him about compatibility, that he will put both meds in a syringe and put them in his pocket for a few minutes and check for precipitate. He told me that is the main problem with incompatibility, that the IV line will be occluded.

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Specializes in med surg.

I never have put anything up with TPN, most of our patients have a triple PICC and we just use another port.

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Specializes in M/S, Travel Nursing, Pulmonary.

Well, I agree, pharmacy will tell you things are not compatible.......but I dont think thats because thats just a patt answer. If you look at the chart for compatibility and read the legend, there is a symbol for.......I forget what it says........something about "needs more data" or "different test values" or something. Basically its not a yes or no. There are so many combinations that give that answer. Pharmacy's way of dealing with that, and mine to......is to consider it not being compatible.

I too have run into this though. A lot. More than I'd like to admit. I've seen crystals forming in a line that was there for a pt. I just got and I'm......amazed.

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I work in peds, and we most definitely DO run stuff with TPN and lipids. Sometimes we are very lucky to have one line in, and we don't want to turn off the TPN/lipids unless absolutely necessary.

We do not have a unit policy on this. My frustration is that pharmacy gives us very inconsistent answers.

But again, I've never had a problem with precipitate or interactions.

The one single thing that we will ALWAYS run by itself, is blood.

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This is something I find disturbing. Did you even ask what was in the tubing that was green?

oops, sorry, I completely forgot to mention that the 'green' was Avelox! That's what I meant -- so for example, I knew that the PB was almost done infusing because the bag was pretty much empty and the primary line was pumping NOW (after being delayed) and there was still some avelox left in the tubing leading to the patient.

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Specializes in CVICU.
It does disturb me to find that many nurses do not know that practically everything is incompatible with Bicarbonate. Several times I've found antibiotics piggybacked into a line with bicarb in it. So I took to writing on the mar "Warning: not compatible with ____ !"

Actually this isn't as bad as you think. We use Micromedex at work and I was always told that this was the case. However, I hadn't actually looked it up. I has a patient the other night who was on multiple pressors, a bicarb drip, TPN/lipids, and lots of abx. As it turns out, I believe Neo and Levo are actually compatible per Micromedex. I can't remember if it was those two or one of the abx, but I ran them together and it was fine.

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Specializes in CVICU.
Never ever hang anything with TPN...

We only hang ranitidine and insulin with TPN/lipids. Some of our TPN has the ranitidine added in already.

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Specializes in MSP, Informatics.
I was told by a pharmacist at my last place of employment that when a nurse calls to ask him about compatibility, that he will put both meds in a syringe and put them in his pocket for a few minutes and check for precipitate. He told me that is the main problem with incompatibility, that the IV line will be occluded.

wow, that is an odd way to do it. After 8+ years of higher education. Resort to that. Some things are Y site compatable, some are mixture compatable. (i.e. mixing up a cocktail of antibiotics, as some facilities do) some can be run in the same tubing after flushing the tubing.

I have seen meds form a precipitate, even when they are compatable.... I always wonder if it may have been something hung prior on that tubing, and the IVPB bag taken down later...and some residue remains. You can't always know what happend 10 steps before you took over the shift. I guess thats why when we hang something we stick arround to make sure it is running correctly before you leave the room.

A good up to date drug book is invaluable.

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Specializes in med/surg, telemetry, IV therapy, mgmt.

I was an IV therapist for many years. You wouldn't believe what we found running on IV lines that we were called for to restart. One that I recall was an IV that our team had been called to restart for the 3rd time in 24 hours. I got the 3rd call. They had 50% Dextrose running on a peripheral IV and they were piggybacking ATBs into it! The patient's central line had been d/c'd the day before and some knucklehead never changed the IV fluid or notified the pharmacy. Nor had two other IV therapists checked to see what was infusing into the line. My favorites were Dilantin hung on lines of D5W and being called when the nurses couldn't get the lines to run--they look like deer with lights in their eyes.

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Specializes in Critical Care.
oops, sorry, I completely forgot to mention that the 'green' was Avelox! That's what I meant -- so for example, I knew that the PB was almost done infusing because the bag was pretty much empty and the primary line was pumping NOW (after being delayed) and there was still some avelox left in the tubing leading to the patient.

OK, now I hve to go look up what Avelox is and why it's green. :lol2:

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Specializes in Utilization Management.
OK, now I hve to go look up what Avelox is and why it's green. :lol2:

Here's a picture. As you can see, it has a kinda greenish tint.

avelox_12896_1.jpg

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