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

Nurses General Nursing

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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' ??

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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.

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Specializes in Post Anesthesia.

Pharmacy is never going to tell you that anything is compatible with anything else. There is just no absolute list. Some things are certified by the drug companies as compatible but until proven otherwise, everything else is incompatible from a pharmacy standpoint. Just because pharmacy says it's incompatible it dosen't necessarily make it so. You may want to try trusting the judgement of the more experienced staff unless they have proven untrustworthy in the past. They are your peers- doing the same job as you. Pharmacy is a whole other department with liability anxieties of thier own.

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Specializes in Infusion Nursing, Home Health Infusion.

OK I would like to weigh in here. First of all you can have a physical incompatabilty,which would most likely create a precipitate, then there is a chemical incompatability that could render one both or all drugs that were mixed ineffective or usually not as effective. You will not always see a physical reaction if drugs are incompatable. In response to a previous answer...just b/c your IV line is still functional does not mean that all is OK. A precipitate could have been infused into the patient or the medications may not be as effective. I have learned that just b/c policies are in place not everyone reads them or uses all of them. Most hospital pharmacies have approved references to use. I personally like and use Betty Gaharts IV Medicatios book. Every Iv drug has a list of what is compatable and not...and yes you can tust the list. if a drug is new ot its comaptablity is unknown it will say something like...not compatable with any other iv drug. What I did when I worked med-surg a lot was make a list of the most common drugs and drips used and made my own chart. One medication I often find mixed or hung as a secondary is Flagyl and it should not be. what you can do is make your list and chart and then share it in a staff meeting...if you make the quide easy nurses can carry it around with them on their shifts. Also make sure your unit has a reference book available or select a good and fast on-line reference if you can. You also need to bring this up with your nurse manager.....but come with a solution in hand that way you are a problem solver and an educator and NOT a complainer. it is OK to move forward with this....you are being a patient advocate and a member of the health care team....let us know what yhou decide to do!!!!!

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Specializes in Med Surg, LTC, Home Health.

Indeed i have seen (a few times) nurses that administered calcium gluconate to pts on ceftriaxone. Calcium products should not be given to pts on Rocephin for 48hrs due to a risk of precipitate. Nonetheless, in the times where i saw this, thankfully nothing happened.

I do believe however, that nurses should not be flippant about what the pharmacy says is compatible or incompatible. We call to ensure the safety of our pts, and we do so because the pharmacists are the experts. It doesnt matter what other nurses do or say, because in the event of an adverse reaction, i doubt they will be there to step up and take the blame for telling you it was ok, or that it would even matter if they did. It is your patient!

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Specializes in Acute Care Cardiac, Education, Prof Practice.
Pharmacy is never going to tell you that anything is compatible with anything else. There is just no absolute list. Some things are certified by the drug companies as compatible but until proven otherwise, everything else is incompatible from a pharmacy standpoint. Just because pharmacy says it's incompatible it dosen't necessarily make it so. You may want to try trusting the judgement of the more experienced staff unless they have proven untrustworthy in the past. They are your peers- doing the same job as you. Pharmacy is a whole other department with liability anxieties of thier own.

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

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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

We have that chart. Frustratingly it does not have TPN/lipids, which always a question.

As for flagyl, I always call the pharmacy, and it seems like I get a different answer depending on who's working that day.

I really wish there was one really trustworthy source we could go to ourselves.

That said, I've never had a problem (that I know of) d/t incompatability.

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Specializes in Critical Care.
(with some green leftover in the tubing.)

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

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We have that chart. Frustratingly it does not have TPN/lipids, which always a question.

As for flagyl, I always call the pharmacy, and it seems like I get a different answer depending on who's working that day.

I really wish there was one really trustworthy source we could go to ourselves.

That said, I've never had a problem (that I know of) d/t incompatability.

Never ever hang anything with TPN...

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Another good reason to have a PDA... with drug/IV incompatibilities.. quick easy.. safe :) if still in doubt.. call pharmacy!

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Specializes in Utilization Management.

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 ____ !"

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Specializes in Acute Care Cardiac, Education, Prof Practice.
Never ever hang anything with TPN...

Agreed. We never run anything with lipids, and only run abx with TPN if pharmacy has thoroughly investigated the interactions and we have absolutely no choice. But then I always turn off the lipids during the process. I think I has this special situation once so far in my career.

Tait

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