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.

[megRNn]

Pause pump, flush the primary line from the port nearest the patient, give med, flush again (10cc), resume pump.

[trinitymaster]

BTW, IV Valium is incompatible with EVERYTHING. Give it as close as possible then flush like a ......(Shut your Mouth).

One thing to consider is that once it enters the heart, everything is compatible.

Interesting side note: Precipitate will cause a warm fuzzy feeling that will last for a few minutes.

That feeling you get when you combine the PRN IV narcotic with another med and it precipitates.

[Sara-Allison]

My concern was with residual med left in the primary line for incompatible meds. That is probably the reason why when I was given a fast education we just assumed incompatible meds, and always disconnected the iv tubing, flushed, gave med, and flushed again. Is this practice where one disconnects the IV tubing for IV push a common practice.

[Julius Seizure]

I would say that the answer to your question is that the common practice is to look up the compatibility. You will need to be looking up a lot of meds at first anyway to be sure you are familiar with what you are giving, so you will already be in the drug book/online resource. Just look at the compatibility at the same time. Also, generally your primary line will be something like NS, or D5NS, so many BUT NOT ALL things will be compatible. In most instances, pausing the pump, and flushing before and after will be plenty fine. Check your unit policy, use your coworkers as resources when you have questions, and look up the drugs you aren't sure of.

[calivianya, BSN, RN]

My concern was with residual med left in the primary line for incompatible meds. That is probably the reason why when I was given a fast education we just assumed incompatible meds, and always disconnected the iv tubing, flushed, gave med, and flushed again. Is this practice where one disconnects the IV tubing for IV push a common practice.

I would say it's not common practice because you just turned the IV tubing from continuous to intermittent, at least by the policies most places I've worked. That means you just made more work for yourself because you should now be changing the tubing every 24 hours instead of every 96 since the line is no longer continuous.

Any time you are repeatedly disconnecting and reconnecting lines you are increasing infection risk for your patient. This gets extra important if you are doing this with centrals/PICCs, but it's still important to keep in mind with peripherals.

If your tubing has a port very close to the patient it's fine to use that. Just pause the fluids (I also like to clamp the line right above the port, just personal preference), flush with NS, give the med, flush with NS again, and restart your fluids.

[stardustmage]

I would also say leave a comment on the MAR if you are able to about compatibility if you talk to the pharmacist and are able to, that way others are aware. I especially make sure to leave a note on the MAR if someone is getting a med that isn't compatible with NS- there are a few!

[Sara-Allison]

Thank You.