Heparin Drip Compatibilty

[Advocate1]

So today pt pt was ordered a Heparin drip and IV abx. One abx was Vanco - which is not compatible with heparin - the other abx was Azactam (sp?). When I looked its compatibility with Heparin up it said it was compatible at the Y-site. I ran the Abx on its own pump and connected it to the Y-site on the Heparin line

I called pharmacy just to double check. they agreed. Then, another RN with many more yrs experience than I, (been an RN for 6 mos) said that NOTHING is to run with heparin- "Per hospital policy"

I looked up our policy and it said verbatim, "It is not recommended" but Heparin was NOT included in the list of meds that had to be run by themselves.

What do u think about this? was I wrong to run the abx and heparin?

Just wondering

[AprilRNhere]

No- not wrong. But..follow your hospital's policy. You did the right thing by looking it up...and verifying with pharmacy. But..if they say nothing with heparin...I'd just go with that.

[AprilRNhere]

I wanted to add...if it were the other way....if they said yes...and pharm said no...then I'd be more adamant about the decision.

[Advocate1]

I guess what I am wondering is "Why?" I wish someone could explain the rationale for such a policy.

Any Ideas?

[UM Review RN, ASN, RN]

I'm sure there are plenty of reasons, but my choice would be that Heparin needs to be a dedicated line so that people understand that it's a critical drug that can cause death if not administered properly.

Can you imagine the problem if the antibiotic rate is administered with Heparin?

I've seen things like this happen. Very scary.

[GrumpyRN63, ADN, RN]

I'm sure there are plenty of reasons, but my choice would be that Heparin needs to be a dedicated line so that people understand that it's a critical drug that can cause death if not administered properly.

Can you imagine the problem if the antibiotic rate is administered with Heparin?

I've seen things like this happen. Very scary.

Iagree, we NEVER piggyback anything into a heparin gtt, not even maintenance IVF, probably b/c of the above, but what about interruptions w/the rate?you will end up switching off the heparin for 1-2 hrs for the vanc. I just think the chances of running that heparin in at the secondary/piggyback rate are too great.. dedicated line

[Advocate1]

Angie.. I completely agree with you on that front, but in my situation heparin was on it's own pump and so was the abx, they were connected at the Y-site.

Do u think that should be allowed?

[UM Review RN, ASN, RN]

Again, I'd prefer to have two separate lines with two separate IV's and dedicate one to only heparin.

But always check with your Pharmacist and follow what your hospital protocol dictates to be safe.

[al7139, ASN, RN]

At my hospital, we always have heparin on a separate line. If the pt is receiving other IV meds, we start another line. The same goes for other high risk meds like NTG, Dobutamine, etc.

I prefer to be safe, and would never run another med through a line with heparin infusing, even if the policy said otherwise...too much room for error!

Amy

[psalm51]

agree on NOT NOT NOT running anything with heparin.

[ErinSRN]

I actually just had this same problem arise at my hospital and got reprimanded for it. Two separate pumps y-ed together. However, all of our reference books, the pharmacy, and our interaction database said it was acceptable. We do not have a nursing policy related to heparin infusion either.

I've been doing a lot of research and have come to a couple of conclusions:

First, I think the general refusal among seasoned nurses to hang heparin with another medication is that they were trained in a time before IV pumps, when using the Y-site to run another medication could potential alter the rate of the heparin infusion. Running heparin without a pump would terrify me! However, with a pump, the correct dose is administered consistently, so we needn't worry about that.

I think in an ideal world, heparin would have a dedicated line. However, the world is not ideal and if a patient does not have veins that make multiple IVs a viable possibility, I think it saves the patient undo discomfort to use the y-site. Also, every invasive line increases the possibility for infection, so it may not always be best to have dedicated lines for heparin if the other medications are compatible.

We should be using evidence-based practice, not tradition, to determine our practices. I think if a hospital does not want this to happen, the policy should be clear and pharmacists as well as nurses should know about it.

[franciscangypsy]

We run meds with heparin all the time... as long as they're compatible. We have too many people who we can only get one IV site on.

If I don't have to run heparin with another med, I don't. But I don't sweat it if the meds are compatible. And I always check med compatibility before running anything with heparin.