How to give IVP into a primary line with incompatible medications?

[Sara-Allison]

Have you ever used IVP into a primary line?

When I was trained we only used saline lock to give IVP, and the IV line was always disconnected.

We generally assumed incompatibility and did saline flush 5 ml medication flush 5 ml.

I understand that we can give IVP into a primary line, but am concerned about compatibility of medications, and lack of time on a med surg floor.

How do you handle IVP into a primary line with incompatible medications?

Thank you in advance.

[ArmaniX, MSN, APRN]

Just run them all together and hope for the best!

But.. seriously, your work place should provide you a resource to view IV compatibilities. It may take some time initially but eventually you will remember the compatibility of the IVPs you usually give on your floor. Take the time to look the drugs up and familiarize yourself with them. It will benefit you in the future.

[Sara-Allison]

Is there an application that will have IV compatibility for my mp3 player?

[CBlover, BSN, RN]

Honestly, I've never run into an incompatibility issue with IV push meds and a primary line. If I did, I would just disconnect the primary line and give the drug and then flush then reconnect. That simple. Will only take a second.

[Sara-Allison]

Do you check for compatibility or do you just disconnect the primary line and give the drug and then flush.

What I have been taught is to just give push med through a disconnected IV. We never really gave IV push through primary line. So we would flush, give med, flush never with use of IV. I was thinking I could just take distal port flush, give me, and then flush again. Then restart iv. This way if the med was incompatible, and I needed to use the primary line, I have already flushed with 3-5 ml ns.

[Postpartum RN]

I do give ivp sometimes into primary line, just be careful since the tubing is longer than a saline flush, that when you push the med it actually reaches the pt before pushing your flush, and usually for this reason I flush slowly after giving a med. So I pause IV, flush, give med, slow flush, and restart IV.

[trinitymaster]

Boy oh Boy....Ain't nothin' like seein' the inside of the IV line turn into a little snow globe....be careful

[Sara-Allison]

The little snow globe reaction is not one that I would like to see. It's just that the time on the med surg floor is going to be short, so taking the time to look up every med compatibility will take too long. So when I was trained, we just presumed incompatibility and flushed everytime by disconnecting the iv. The tubing was much shorter, so I was concerned about using the port closes to the patient with the IV as I had never actually seen anyone use it to give an IVP especially with incompatible medications.

[Sara-Allison]

That makes sense to make sure the saline flush flushes the whole tubing, and that the med actually reaches the patient. If I flush the whole tube, push the med, flush the whole tube again making sure to push the med down with the last flush, that should do it, and I wont have to worry about incompatibility. Is that right?

As I am assuming that all meds are incompatible. Comments?

[Karou]

The little snow globe reaction is not one that I would like to see. It's just that the time on the med surg floor is going to be short, so taking the time to look up every med compatibility will take too long. So when I was trained, we just presumed incompatibility and flushed everytime by disconnecting the iv. The tubing was much shorter, so I was concerned about using the port closes to the patient with the IV as I had never actually seen anyone use it to give an IVP especially with incompatible medications.

It's actually critical that you take the time to look up medication compatibility. You HAVE to know this information before giving any drug. "It will take too long" is not an excuse, it's lazy and dismissive. Medsurg is crazy, chaotic, and fast paced, but it is expected of any nurse to know what medication they are giving before they give it and know what it is and isn't compatible with.

Once you have LOOKED it up, and you know an IVP medication is incompatible with the primary infusing (continuous or intermittent) medication/fluid, then you need to pause and unhook the primary, flush with NS, administer the medication, flush with NS, and hook up/resume the primary. If you are unsure about compatibility then you need to do this. You shouldn't be unsure though, you should look it up and KNOW.

Eventually you know what is compatible and what isn't by memory.

If your online drug resource or drug book doesn't know compatibility (ours never does with clinimix for example) then you need to call pharmacy and ask.

[Levitas, BSN, RN]

If I am ever unsure of what is, or isn't compatible, I simply call the Pharmacist. If they're unavailable, I look it up.

As others of said, you'll eventually start to memorize what is, and isn't compatible. But until then, use your resources, that's what they're there for :)

[Karou]

I do give ivp sometimes into primary line, just be careful since the tubing is longer than a saline flush, that when you push the med it actually reaches the pt before pushing your flush, and usually for this reason I flush slowly after giving a med. So I pause IV, flush, give med, slow flush, and restart IV.

If you are giving something truly incompatible (as the OP is suggesting) then why would you do this instead of pausing/unhooking the primary IV and giving the IVP directly into the port of the IV? What if residual medication residue is in the primary tubing and has a reaction with the incompatible primary fluid/mediation? Is it because unhooking it would take too long? Are you rushed? I just don't understand why this is preferred over unhooking/pausing the primary...