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

[ANH_RN]

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' ??

[suanna]

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

Kinda pretty- peridot colored! And it does wonders for MRSA too!!

[suanna]

I am sorry for whatever pharmacy you have to work for if their primary goal in patient care is giving incorrect information for the sake of "covering their own butts". Working on a med-surg floor we frequently use our pharmacy to question compatibilities and I would not personally "distrust" them and only refer to my own "peers". I often find that nurses on the floor do NOT take the time to understand compatabilities, and even someone with years of experience can be caught in a routine that proves unsafe at times for thier patients.

I'm sure pharmacy is giving the best information they have but they don't have much information. Asking them to say a drug is compatible is like asking them for a weather report on Mars- Not something they have the ability to know. At my hospital pharmacy says all drugs are incompatible if the package insert dosen't specifically say that it is compatible. Virtualy no drug companies do compatibility research on every other possible drug combination-it's just not practical. I'm just practicing nursing- I don't have it perfect yet by any means, but If I went only by pharmacys input every patient I have would have 10 different IV sites. I work critical care- You can't stop the patients levophed and dopamine to hang thier antibiotic- I don't care what pharmacy says. Pharmacy is a resource- and just that, experienced RN staff and personal judgment play a big role in this issue.

[tihne_13]

In the first world countries like the US u rarely see those things in their hospital setting because that is obviously negligence. But in other countries like the 3rd world it is common. Just do the proper or ideal way and not go after the wrong means of some of ur colleagues. Remember ur handling lives...:saint:

[patrick1rn, MSN, RN, NP]

I am sorry for whatever pharmacy you have to work for if their primary goal in patient care is giving incorrect information for the sake of "covering their own butts". Working on a med-surg floor we frequently use our pharmacy to question compatibilities and I would not personally "distrust" them and only refer to my own "peers". I often find that nurses on the floor do NOT take the time to understand compatabilities, and even someone with years of experience can be caught in a routine that proves unsafe at times for thier patients.

To the OP: Continue to be diligent in your IVPB compatabilities. Learn from your pharmacy and if there is a severe compatability issue on a patient that has been breached talk to your manager about an unusual occurence or whatever your procedure is for potential patient harm write-ups. These UO's are often to used to find gaps in the system that can result in patient harm (NOT to get "nurses in trouble" as so many people like to assume).

Chances are there may be a generally accepted norm about certain IVPB meds on the floor that hasn't necessarily harmed anyone yet, but may in the future.

Also utilize your drug books (I buy a new one as a Christmas present each year for our floor) and here is a link to a potential IV compatability chart I might be getting for our floor as we are lacking one.

http://www.kingguide.com/proddetail.asp?prod=09-cc-chart

Tait

You buy a drug book for the floor you work on ? Your hospital doesnt supply your floor with a drug reference ?

[tryingtohaveitall]

I also work in peds and all too often you only have a few lines to run multiple meds as well as vasopressors, Hal and lipids. Many medications are compatible with both hal and lipids, but we always verify before hanging.

One thing I would NEVER do is infuse antibiotics with vasopressors (as has been previously mentioned here). When you do that, you are essentially bolusing the patient initially, then when you stop the extra flow of the antibiotic, you will significantly decrease the amount of vasopressor they're getting until it catches up to where it was before the ATB was started.

This may not be an issue in older/bigger patients with higher flow rates, but it is HUGE in pediatrics. Recently, I had a newbie nurse and a few scared residents in a room with a patient who had suddenly dropped his heart rate. After asking a few questions, it turns out that the vasopressor was infusing with the hyperal. When the nurse increased the hal rate, it temporarily increased the flow of the vasopressor, increased the kid's BP significantly and to compensate, he dropped his heart rate. After a few minutes, the effect wore off and all was well. It taught the nurse a huge lesson to be careful about what you infuse with pressors and rate changes!

[Tait, MSN, RN]

You buy a drug book for the floor you work on ? Your hospital doesnt supply your floor with a drug reference ?

When I started on this floor we had two drug books. One was from 2001 with a chunk of the index missing, and one from 2004.

So I just decided to pick out one that I really liked and drop the $40 each year so I had the resource I needed.

Tait

PS. I floated to another unit and when I asked where the drug book was (first time I had to mix Phenytoin on the floor) they looked at me like I was from Mars. I guess everyone relies on the one in the PIXIS, but for me I like to get my hands on a book and not hold up a busy line of nurses attempting to get thier night meds.