Incompatible drips

Specialties MICU

Published

Running incompatible drips in different lumens of the same line... Thought??!

Specializes in Oncology/Haemetology/HIV.

If the PICC or other central line is placed properly, the end terminates in the correct place (SVC near entrance of the atrium), the blood flow should be so rapid and turbulent, that the infusions are mixed rapidly in the blood stream. This, there is not enough contact between the infusions for them to precipitate.

This is one reason, that if the PICC pulls out partially from the site, positioning is checked to insure that it is still a central access, not midline/peripheral.

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Specializes in Nurse Anesthesiology.

Just because someone from pharmacy or your unit says something doesn't mean it's correct. I simply asked you to prove me wrong with actual evidence which you haven't provided me. Everything in my practice is done based on evidence and actual research not just because things have always been done a certain way or because someone says so.

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If a pharmacist who went for school for many more years than I said something isn't compatible as well as Micromedix, which is evidence based it's pretty obvious you should listen.

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Specializes in Nurse Anesthesiology.

Enjoy being that nurse who just does what they are told and not think on their own. Many nurses are just like this so its ok.

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Enjoy being that nurse who just does what they are told and not think on their own. Many nurses are just like this so its ok.

Have you not looked at Micromedex and seen the tests done where certain drugs develop line precipitate when mixed together?

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Specializes in Nurse Anesthesiology.

I have been combining vasoactive drugs for years and have not had a single issue or had any precipitate in my lines. Same thing I find funny when I hear a nurse say they can't give said vasoactive drug through a peripheral IV. Guess what? I use them all the time through IVs in the OR and no complications. Like I said unless you can provide me with actual clinical based evidence you have no validity.

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I have been combining vasoactive drugs for years and have not had a single issue or had any precipitate in my lines. Same thing I find funny when I hear a nurse say they can't give said vasoactive drug through a peripheral IV. Guess what? I use them all the time through IVs in the OR and no complications. Like I said unless you can provide me with actual clinical based evidence you have no validity.

I did not say vasoactive drugs specifically. I have not seen any pressors that are not compatible. I said drugs. There are in fact studies that have been done that show precipitate with mixture.

As far as vasoactive drugs through an IV, you can give them through peripherals, but there is an increased risk of infiltration as they are vesicants. I have read studies as well on their use and the incidence of infiltration.

Just because you have apparently failed to read the research doesn't mean that it isn't out there.

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Specializes in Nurse Anesthesiology.

So please enlighten me with these studies or tell me what drugs you are referring to besides Lasix bicarb mannitol?

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Wow, seriously

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Specializes in Critical Care.
I have been combining vasoactive drugs for years and have not had a single issue or had any precipitate in my lines. Same thing I find funny when I hear a nurse say they can't give said vasoactive drug through a peripheral IV. Guess what? I use them all the time through IVs in the OR and no complications. Like I said unless you can provide me with actual clinical based evidence you have no validity.

The formation of precipitate is one of a few problems caused by incompatibilities. Precipitate is just one effect of a physical incompatibility, there are also chemical and therapeutic incompatibilities. I find a bit concerning that you limit the possibility of complications to only what is immediately evident in the OR. A zosyn/insulin incompatibility, for instance, occurs because the insulin when combined with zosyn at the concentrations they are at while running together causes cell apoptosis of piperacillin, which means if you run the to together you're only infusing the cellular waste products of a formerly effective antibiotic. There would be nothing apparent at the time that this incompatibility had occured. When an infection takes hold down the line due this error it would be nearly impossible to track it back to the failure to recognize the incompatibility.

In terms of evidence, resources for incompatibilities are all based on actual research into the combination of various drugs. It's these references that pharmacists refer to when they tell what is incompatible. Not all drugs are tested due to a lack of potential for incompatibility, but all reported incompatibilities are confirmed through various testing processes, which many of these sources provide access to. There are exceptions to these incompatibilities, usually based on concentration, but unless you know you are using concentrations that fall below the threshold of a clinically significant incompatibility you do need to assume an incompatibility.

Most of these references require a subscription (trissels, kings, etc), but here's a quick reference that doesnt' require a subscription.

http://www.pharmacypracticenews.com/download/IV_drugs_ppnse13_WM.pdf

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lol... I guess Micromedics lists incompatibilities between drugs just for fun! And I'm glad you think that having pharmacists is a waste of hospital resources. Just because there is no "precipitate," does not mean that there isn't any type of reaction occurring... You have got to be kidding me! You should really be ashamed of your practice. I wonder how many patients that you have injured because of your incompetence...

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I have been combining vasoactive drugs for years and have not had a single issue or had any precipitate in my lines. Same thing I find funny when I hear a nurse say they can't give said vasoactive drug through a peripheral IV. Guess what? I use them all the time through IVs in the OR and no complications. Like I said unless you can provide me with actual clinical based evidence you have no validity.

You've been combining vasoactives for years without problems because all the pressors are compatible. If you've ever used the tool Micromedex it will tell you exactly what will happen if you mix incompatible drugs - going down to which manufacturer of each drug was mixed with the other drugs manufacturer.

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