Skip to content
View in the app

A better way to browse. Learn more.
allnurses

A full-screen app on your home screen with push notifications, badges and more.

To install this app on iOS and iPadOS
  1. Tap the Share icon in Safari
  2. Scroll the menu and tap Add to Home Screen.
  3. Tap Add in the top-right corner.
To install this app on Android
  1. Tap the 3-dot menu (⋮) in the top-right corner of the browser.
  2. Tap Add to Home screen or Install app.
  3. Confirm by tapping Install.
Discussion

incompatible iv medication

Just curious if 2 incompatible medications were hung together via Y site, would precipitate always form? I was told lower chance b/c of a y-site being used. If so how long does precipitate stay in blood stream before it dissolves? or would a reaction from the patient occur right away? Thanks!

  • Quote

    • Featured Replies

    Some IV meds are NOT compatible, even at the y-site. Look the meds up in a drug book, it will tell you what is compatible at the y-site. You do not want the meds to precipitate. With experience you will learn more about IV meds.

  • Quote

    "

    just curious if 2 incompatible medications were hung together via y site, would precipitate always form? i was told lower chance b/c of a y-site being used. if so how long does precipitate stay in blood stream before it dissolves? or would a reaction from the patient occur right away? thanks!"

    call me a cranky ol' thing, but didn't you take chemistry? there was a reason for that-- to give you an appreciation for what precipitation looks like so you would have that image in your mind. did you take physiology, anatomy? there was a reason for that-- to give you an appreciation for how teeny capillaries are, so you can imagine what would happen when precipitated crystals get into them. and to tell you to figure out where those crystals fetch up when you drop them into a vein (i"ll wait while you trace the venous pathway to..... **).

    also, what if those crystals don't dissolve? or if they do, they dissolve into substances that aren't therapeutic?

    "i was told that..." is never a substitute for education. what part of "incompatible" is hard to understand?

    **(the pulmonary capillary bed)

  • Quote
    • Experts

    There are many reason's something is incompatable. It is not only precipitate that forms. The precipitate may be cloudy or crystalized or it may inactive a necessary med like dopamine and bicarb

    The compatibility or incompatibility of IV medication is an important consideration in drug administration, especially since it is not unusual for multiple drugs to be administered through y-site connectors on continuous infusion administration sets. Even if patients are receiving different medications through multiple lumens of central venous catheters, care must be taken to assure that drugs administered into the same lumen are compatible.

    Visual: A visual incompatibility is characterized by the presence of precipitation (visible particles seen floating in the solution), gas formation (solutions may appear carbonated), color change (drug references will tell you the correct appearance of an admixed medication in a solution), or turbidity, where medications do not mix easily into solution.

    Chemical: This often involves the degradation of drugs to produce therapeutically inactive or even toxic solutions. Chemical incompatibilities may not be accompanied by any visible clues.

    Equivocal Compatibility: Compatibility is reported as equivocal in situations in which signs of possible incompatibility are transient (such as turbidity that is resolved during a short time period, uncertain, or inconsistent).

    Solution instability: This is when a medication comes out of solution or degrades due to the length of time it has been admixed or some other factor, such as temperature, or light exposure. Other factors influencing solution stability are the dose and concentration of the drug, the number, type, and order of additives to a solution, the type and volume of parenteral solution (for example, the electrolyte content of many parenteral nutrition solutions can alter the stability of most IV medications. This is an example of complexation, where two or more compounds in a solution form a chemical complex that inactivates one or both of them).

    Therapeutic incompatibility: The largest class of incompatibilities is therapeutic incompatibility, which occurs when an undesirable pharmacological reaction occurs within the patient as a result of two or more incompatible medications concurrently. These medications do not necessarily have to be given via the same route. It is imperative that the pharmacy be aware of ALL medications, dietary supplements, and over the counter medications that a patient has been taking in order to prevent known therapeutic incompatibilities.

    To prevent incompatibilities, it is important to consider all the ways in which medications may interact outside of or inside the body. If you must mix a medication, always follow manufacturer’s instructions as to the correct volume and type of diluent; which solutions it may be added to for "piggy back" administration; and what flush solutions must be used in between administrations to prevent events like precipitation within the patient’s access device (for example, never administering phenytoin into an intravenous line containing dextrose, or never allowing amphotericin B to come into contact with saline solutions). Other issues to consider are the presence of electrolytes (e.g. potassium chloride) mixing into continuous infusions, such as in a piggyback situation. If mixing medications in a syringe for bolus administration (IV push), assure that they are compatible when combined in a syringe. If consulting a drug reference is not helpful, contact the pharmacy, which has access to additional compatibility information.

    Be on alert for medications with a known history of frequent incompatibilities when they come into contact with other drugs. Among the drugs most often incriminated in incompatibilities are furosemide (Lasix), phenytoin (Dilantin), heparin, midazolam (Versed), and diazepam (Valium) when used in IV admixtures.

    Some tips for the bedside:

    Always watch for any change in the appearance of IV solutions (color change, gas bubbles, precipitate) in bag or tubing after mixing a medication or administering it into a Y-site on an IV administration set.

    Keep a compatibility chart handy in your medication room or on your medication cart (in back of the kardex is ideal, if used) to re-verify compatibility if two medications are to be given concurrently into the same IV line.

    Don’t forget to check for any incompatibilities with additives that have already been added to the patient’s primary IV solution (e.g. potassium chloride, multivitamins. These can be incompatible with many medications because of pH.).

    Don’t piggyback any medications into parenteral nutrition lines unless the pharmacy verifies the safety of doing so. Many of the electrolytes added to the mixture are incompatible when they come in contact with many common infusion medications. This is not a recommended practice, due to the risk of infection as well.

    Some reactions are immediate some are not......if the crystals are big enough it can cause an emboli and they don't disolve can be fatal. SOme can be OK toghther when they are y connected some are not. Some you need to flush before and after administration. It is absolutely imperative to follow pharmacy recommendations on meds. I have used it in the past and have found it very useful and they have an app is micromedex and it can run compatibility searches for you from your phone or Ipad.

    http://www.enotes.com/nursing-encyclopedia/M

    http://www.healthline.com/galecontent/intravenous-medication-administration

    http://www.globalrph.com/dilde.htm

    http://www.clinicalpharmacology-ip.com/help/clinical_content/clinical_pharmacology_drug_monographs.htm

    Some reference sites for you.....:)

  • Quote

    Precipitation may not always form. It is possible that chemicals react with one another and one becomes more/less concentrated, which could adversly affect the patient. Best to look them up. There is a free app to Micromedex for iphones and droids.

  • Quote
    • Author

    thanks guys! unfortunately I have seen incompatible meds hung together a couple times, meds that could cause precipitation when combined. Incident reports were done both times, and the patients were ok luckily. I was just curious what happens to the precipitation, just curious if it did dissolve eventually (I know worse can happen). One of the times the med was hung via Y-site and a pharmacist told me b/c the two meds were not in contact for very long this may have not given the medication enough time to form precipitate. Thanks for ur time!

  • Quote

    If you ever see a drug precipitate in a syringe (I'm thinking of Valium- in saline, I think (been a while ago- like 1986!) you wouldn't think that it would EVER dissolve. It turns into jello.

    Never hope that anything will eventually dissolve in an IV. Too risky :)

  • Quote
    • Author

    nope never seen that! Does not sound good. I'm just wondering why no reactions were seen by these two patients thats all. Just wondering if the medications were eliminated in the usual manner. thanks all. I work tomorrow so I can always ask the dr. or pharmacist too!

  • Quote
    nope never seen that! Does not sound good. I'm just wondering why no reactions were seen by these two patients thats all. Just wondering if the medications were eliminated in the usual manner. thanks all. I work tomorrow so I can always ask the dr. or pharmacist too!

    OR, you can look it up yourself first , so you have info to present to the pharmacist (the doc only orders the stuff- not give it :D)

  • Quote
    nope never seen that! Does not sound good. I'm just wondering why no reactions were seen by these two patients thats all. Just wondering if the medications were eliminated in the usual manner. thanks all. I work tomorrow so I can always ask the dr. or pharmacist too!

    Maybe because such tiny amounts of the meds are available in an IV tubing and there isn't enough substrate for reaction to occur.

  • Quote
    nope never seen that! Does not sound good. I'm just wondering why no reactions were seen by these two patients thats all. Just wondering if the medications were eliminated in the usual manner. thanks all. I work tomorrow so I can always ask the dr. or pharmacist too!

    I'm thinking you discovered this based on empty bags hanging? They may have been hung and run in at different times, thus the tubing flushed in between, just the bags left up there.

  • Quote
    Just curious if 2 incompatible medications were hung together via Y site, would precipitate always form? I was told lower chance b/c of a y-site being used. If so how long does precipitate stay in blood stream before it dissolves? or would a reaction from the patient occur right away? Thanks!

    I reread this.... You don't want ANY chance..:) A Y-site is not a way to deal with incompatible meds. If you only have one line, check your P & P for how to deal with it. The precipitate may never dissolve if the patient has an MI or stroke because of it.....

  • Quote

    "i reread this.... you don't want any chance..:) a y-site is not a way to deal with incompatible meds. if you only have one line, check your p & p for how to deal with it. the precipitate may never dissolve if the patient has an mi or stroke because of it....."

    no, no, no. if you do believe this is possible, i regret that you are not alone, but now you can help others avoid this common error. once again, i implore anyone who believes that this (or a dvt or a bit of air in iv tubing, for that matter) would cause a stroke or mi to follow along with me as we trace the blood circulation pathways. this is why you took anatomy.

    peripheral veins-> vena cava -> right atrium -> right ventricle -> pulmonary artery -> pulmonary capillary bed ->[color=pink] lungs -> pulmonary veins -> left atrium -> left ventricle -> aorta -> systemic arteries

    now, just how does a floating object (crystal, clot, air bubble) go from the veins to the arteries? does it say, "beam me up, scottie," and bypass nature's natural strainer, the pulmonary capillary bed, and then have a clear shot at coronary arteries or cerebral flow? no, it does not. this is, in fact, one reason we have a pulmonary capillary bed-- we are always shooting little venous clots from minor trauma or whatever, and this is where they go to get caught and dissolve harmlessly. big clots, or big air bubbles, different story. but small ones, happens all the time.

    exception, rare: an intracardiac defect in the atrial or ventricular septum could offer a direct pathway between the right and left circulations. however, since the blood pressure in the left side is much higher than in the right (think: 120/80 vs 20/10), one would see what's called a left-to-right shunt, when the blood passes from the area of higher pressure to the area of lower pressure, so even then, it would be very unlikely. right-sided pressure would have to exceed left-sided pressure to make an oject travel from the right side to the left side. this is, however, the commonest cause of strokes in otherwise healthy young people. tedy bruschi, the heart and soul of the new england patriots line and a helluva nice man, did exactly this, probably as a result of a valsalva in the bottom of the pile. valsalva increses venous pressure, popped something thru a previously unsuspected and hemodynamically insignificant asd. clot went to his head, and he suffered a (fortunately very small) cva. he had his atrial septal defect patched in the cath lab and was back at work before the end of the season.

    further pearl: although this explains why you needn't worry about small floaties in the normal venous system, you must worry about every little opportunity for the tiniest bubble or clot in someone with a cardiac defect with a right-to-left shunt, like tetralogy of fallot, single ventricle, really big asd/vsd with elevated right pressures (pulmonary hypertension), hypoplastic l heart with palliative r-to-l opening, etc. they are at risk for mi, cva, or other arterial embolic event; this is a common cause of morbidity/mortality in this population.

  • Quote

    • Join the conversation

    You can post now and register later. If you have an account, sign in now to post with your account.

    Guest
    Add a Comment
    Go to topic listing

    Currently Reading 0

    • No registered users viewing this page.

    Account

    Navigation

    Search

    Search

    Configure browser push notifications
    Chrome (Android)
    1. Tap the lock icon next to the address bar.
    2. Tap Permissions → Notifications.
    3. Adjust your preference.
    Chrome (Desktop)
    1. Click the padlock icon in the address bar.
    2. Select Site settings.
    3. Find Notifications and adjust your preference.