incompatible iv medication

applewhitern, BSN, RN · Aug 8, 2011

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.

nurseprnRN, BSN, RN · Aug 8, 2011

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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)

Esme12, ASN, BSN, RN · Aug 8, 2011

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.....:)

classicdame, MSN, EdD · Aug 8, 2011

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.

maria100 · Aug 8, 2011

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!

xtxrn, ASN, RN · Aug 8, 2011

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 :)

maria100 · Aug 8, 2011

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!

xtxrn, ASN, RN · Aug 9, 2011

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 )

subee, MSN, CRNA · Aug 9, 2011

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.

wooh, BSN, RN · Aug 9, 2011

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.

xtxrn, ASN, RN · Aug 9, 2011

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.....