IV Drug incompatibilities

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Specializes in NICU, Pediatrics.

Hi All,

I'm starting a new job in a level 3 NICU and my job offer is contingent on me passing a NICU pharmacology test. I feel pretty confident about all the topics on the study guide except IV incompatibilities. At work right now (a level 2 NICU), I look up everything in our med book to make sure it's compatible with TPN and lipids before I give it. I just don't trust my memory on this! And we don't give the full range of meds a level 3 NICU would. But for this test, I'm supposed to have the common incompatibilities memorized.

So far I have ampicillin, versed, albumin, acyclovir, gancyclovir, amphotericin B, indocin and ibuprofen, and phenobarb down for being incompatible with TPN and lipids. Am I missing any? Are there any other common drugs you might give at the same time if they were compatible (like 2 antibiotics that can't mix?) Anything else you can think I should have memorized? Thank you so much!

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Specializes in ICU.

I think I remember that Vanco and heparin are incompatible.

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Specializes in NICU, PICU, PACU.

Does the hospital have guidelines? We run Versed and acyclovir with TPN per our guidelines. Are they using Neofax?

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Specializes in NICU, Pediatrics.

I didn't have access to their hospital guidelines, and I don't know if they use Neofax or not. I was studying with a compatibility chart from my school.

http://www.uichildrens.org/uploadedFiles/UIChildrens/Health_Professionals/Iowa_Neonatology_Handbook/Pharmacology/NICU%20Intravenous%20Drug%20Compatibility%20Chart.pdf

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

Are they really expecting you to memorize that whole chart? My experience is that usually they are looking for common NO NO's and things a NICU nurse "should know"

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Specializes in NICU, Pediatrics.

No, I don't think they are expecting that. But I'm not really sure what the big "No Nos" are. The only one I've ever needed to know for my job in a level 2 is that you need to stop the TPN before hanging ampicillin. :down:

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

I'm really adult/pedi....critical transport I wish I could help....let me research a bit.

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Specializes in NICU, PICU, PACU.

I find it hard to believe that they would expect you to know this kind of stuff. I would think things like don't run vasopressors thru arterial lines and fentanyl causes chest rigidity, flush wih D5 before and after Ampho, would be more important Each hospital has guidelines or uses a point of reference (or should). Good luck! I might take a look at a Neofax.

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Specializes in CDI Supervisor; Formerly NICU.

Diflucan needs a separate access site from your TPN. Amiodarone, too.

But, I agree with those who think it's silly for them to expect you to memorize these things. They should more be encouraging you to check your neofax before administering any meds. I've found most people can't count on their memory.

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Never count on your memory..you'll find out quick if you are tired, you'll be more likely to make a mistake.

You'll learn the common ones very quickly, the ones you give most every day. Drugs like indocin, more often than not, will only be given ONCE during the entire stay. So if you rely on your memory for uncommon meds, you'll make a mistake.

Download Neofax...as that is the most common guide.

What you NEED to memorize is compatibility of emergency drugs. If you have a baby that suddenly needs dopamine, etc. you need to find out very quickly how these get set up with TPN/lipids so you can help. WATCH YOUR LINES....when a bed gets surrounded and people start hanging this and hanging that...make sure you label as you go along...you can make it "neat" later.

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Specializes in CDI Supervisor; Formerly NICU.

We had a nurse float into my NICU from PICU the other day. One of her babies was on some cardiac med. The chick wanted to know if it was compatible with the TPN. I asked if she'd looked it up in the Neofax, to which she responded "No, but I mixed some of the medicine with some of the TPN, in a syringe, and I'm waiting to see if it crystalizes."

I nearly fell over. Wonder if that's how they do it in our PICU.

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