Incompatible medications and IV tubing, IV's.

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Specializes in Critical Care.

So I'll admit I stole this topic from another site, but here's the question:

Do your policies allow for medications to be administered separately (not simultaneously) through an IV line so long as the line is sufficiently flushed between medications?

If so, does this also apply to secondary tubing (using a backflush)?

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Interesting question. I'm new at my facility, so I'm not sure what the policies are for Med-Surg and ICU, but for the ED, which is where I work, I haven't actually seen a "policy" per se. I look up my drugs in a drug guide and follow those recommendations.

At my old facility, the answer would have been yes to both.

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Specializes in Med Surg.
So I'll admit I stole this topic from another site, but here's the question:

Do your policies allow for medications to be administered separately (not simultaneously) through an IV line so long as the line is sufficiently flushed between medications?

If so, does this also apply to secondary tubing (using a backflush)?

Don't mix incompatible meds. How you do this is up to you.

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Specializes in Critical Care.
Don't mix incompatible meds. How you do this is up to you.

I'm not talking about mixing incompatible medications, I'm talking about giving incompatible medications separately, and different times, and flushing the line in between, they don't mix. Most sources say this is fine so long as the line is flushed in between.

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Specializes in Pedi.

Yes, this is how we did it when I worked in the hospital. One set of tubing for the primary and one secondary set, each good for 96 hours. We didn't use separate tubing for every medication, we just flushed it after every use.

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Specializes in Trauma Surgical ICU.
Yes, this is how we did it when I worked in the hospital. One set of tubing for the primary and one secondary set, each good for 96 hours. We didn't use separate tubing for every medication, we just flushed it after every use.

This is how I have always done it, however, the facility I now work at has a secondary set of tubing for each medication. Waste of money and multiple breaks in the system open the pt up for infection..I think its one of those "this is how we have always done it"..

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Specializes in Acute Care - Adult, Med Surg, Neuro.

If the medications are compatible, such as Cipro/Flagyl, I will flush back and use the same secondary tubing. If the secondaries aren't compatible, I will get a new secondary tubing (I am not yet brave enough to risk it, LOL) but I have heard that people will still flush back and then hang the secondary.

If the primary fluid and the medication I need to administer aren't compatible, which rarely happens, I will cap off the primary, flush the port/PIV, hang and run the medication, and then flush when it's finished and re-connect the primary. This has only happened once with an antifungal piggy-back I needed to administer.

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Specializes in Critical Care.
If the medications are compatible, such as Cipro/Flagyl, I will flush back and use the same secondary tubing. If the secondaries aren't compatible, I will get a new secondary tubing (I am not yet brave enough to risk it, LOL) but I have heard that people will still flush back and then hang the secondary.

If the primary fluid and the medication I need to administer aren't compatible, which rarely happens, I will cap off the primary, flush the port/PIV, hang and run the medication, and then flush when it's finished and re-connect the primary. This has only happened once with an antifungal piggy-back I needed to administer.

This is what I'm trying to understand (and I don't fault your intentions by any means), but the secondary attaches to the primary and the medication flows through the primary just as it does through the secondary. So when you use a different secondary, but the same primary, it's really no different than using the same secondary, at least as far as I can figure, what am I missing?

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Specializes in CICU.

Muno - you aren't missing anything. I don't think it makes sense to use different secondary (just backflush). It makes even less sense if you aren't also concerned about changing the primary tubing, J-loop and IV catheter due to incompatible meds also..

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Specializes in Acute Care - Adult, Med Surg, Neuro.

That totally makes sense MunoRN, but I just can't bring myself to do it yet. I will next time I guess. I had a bad experience with incompatibilities once.

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The main difference that I can think of is that the primary generally has continuous forward flow of an IV fluid such as NS (or K+/dextrose containing fluid, but nevertheless, still forward flow of an IVF), interrupted only when the secondary med is infusing, while the secondary set only contains the secondary med which sits in the tubing until it is backflushed, and so there is more opportunity for the secondary med to adhere/absorb into the tubing than into the primary tubing. Plus we don't know if backflushing provides the same amount of turbulence as it flows through the lumen of the tubing that continuous forward flow does.

Really, it's all theoretical. It's not studied well at all. Whether risk of contamination r/t manipulation of the infusion set or risk for medication incompatibilities r/t absorption of meds into the tubing or inadequate separation of incompatible meds is a bigger risk, we don't really know, at least as far as I am aware.

This is why I think it is important to follow practice recommendations from bodies such as the INS, because if we don't have evidence one way or the other, we have to have something to base safe practice on besides our own untested theories/superstitions.

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Specializes in Critical Care.
The main difference that I can think of is that the primary generally has continuous forward flow of an IV fluid such as NS (or K+/dextrose containing fluid, but nevertheless, still forward flow of an IVF), interrupted only when the secondary med is infusing, while the secondary set only contains the secondary med which sits in the tubing until it is backflushed, and so there is more opportunity for the secondary med to adhere/absorb into the tubing than into the primary tubing. Plus we don't know if backflushing provides the same amount of turbulence as it flows through the lumen of the tubing that continuous forward flow does.

There's absolutely no reason to believe the physics of flushing is any different depending on the 'direction' of the flush' other than the backflow valve in primary tubing, tubing is not directional.

It doesn't matter if some if it gets absorbed into the tubing, the issue is with widely opposing pH levels, even a 'lazy' flush dilutes the varying pH fluids enough to prevent the formation of any precipitate.

This is why I think it is important to follow practice recommendations from bodies such as the INS, because if we don't have evidence one way or the other, we have to have something to base safe practice on besides our own untested theories/superstitions.

Exactly, this was the basis of this discussion until it got deleted, so what is the recommendation of the INS?

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