IV incompatibility error

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I've been a nurse for 3 months now. I had a patient the other day receiving Lactated Ringers with 20 of potassium. They we're on several IV antibiotics. I didn't even think about IV compatibility and just secondary ran all antibiotics. They included clindamycin, zosyn and dabtomycin.

At shift change the nurse asked about it and said zosyn was incompatible.

I felt bad but didn't really think much about it at the time. Now I'm really freaking out! There wasn't any crystallization but my patient did have high creatinine and kidney issues!

I've been freaking out and nervous that they won't be ok, or that this is a major med error.

This is what I find so difficult about nursing. I feel like I should have reported it right away but I didn't even think about it. Any words of encouragement or advice would be welcome. Thanks.

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Specializes in Critical Care.

The commonly available Zosyn formulations include EDTA, in which case it is compatible with LR. LR is not compatible as a reconstitution solution when EDTA is not used, but those preparations are not particularly common these days if they are even still available.

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Do you know how to hang IV medications? You should always be looking at the monograph to see how to mix the drugs, side effects, indications, run time, COMPATIBILITY, etc. I have ran Zofran IV hundred's upon hundred's of times, and I still always take a quick peek to double check that it is compatible with LR and runs through 15 minutes (even though I know these things).

The fact that you ran "several IV antibiotics" without checking compatibility for any is a huge nursing practice issue to me. Be thankful nothing bad happened to the patient and never forget to do that again. And REPORT your error (think accountability of being a nurse).

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Micromedex, pharmacy, phone a friend...or even just stand there and watch the iv line...you always check compatibility.

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Specializes in Case manager, float pool, and more.

Glad you are concerned for the patient. Now, go to your manager and report it. Take accountability and provide ways you have learned from this and how you can prevent this from happening again in the future. We have all made mistakes and it sucks. Don't beat yourself up.

So, what can you do to prevent something like this from happening again? What have you learned from this? How will you use this to grow as a nurse?

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Always, always, always check compatibility. I look it up even if the off-going RN says it's compatible.

I always check cr clearance as well to make sure the dosing is appropriate. A couple of years agoI had an inappropriate dose scheduled for a patient as their renal function was crummy. Pharmacy didn't catch it. The dose was adjusted to a renal dose.

Case-in-point...A patient whose kidney function was fine on admission was given an antibiotic dose which should have been questioned by anyone who saw the dose. It got by the doc (whether they just put the order in wrong or what, I don't know), got by pharmacy, got by the nurse. There were multiple doses in a 24-hour period that were nothing close to what is normal. The patient ended up on emergent dialysis because of it. Even after the kidney function started to go to crap, no one adjusted doses even then. We're all human and make mistakes, but something like that should no get through THAT many people without being questioned. Always check compatibility and appropriate dosing.

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Aww. This sucks. Yes double check compatibiity. Some places have posters near the pyxis. And start a new line preferably opposite arm if no limb restrictuons..

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Specializes in Critical care.

If it was a Pfizer Zosyn there is no compatibility issue to report. Hospira Zosyn is incompatible.

Cheers

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Specializes in 15 years in ICU, 22 years in PACU.
If it was a Pfizer Zosyn there is no compatibility issue to report. Hospira Zosyn is incompatible.

Cheers

Seriously? You have to check the manufacturer?

We don't hang Zosyn in the PACU much, but they hang it in the OR all the time with LR.

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Always double check. Mistakes happen, and as long as you learn from them, don't let it cloud your head. Just be careful~

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Did you double check that the zosyn was not compatible? Or just go off of what the next shift nurse told you?

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Specializes in Critical care.
Seriously? You have to check the manufacturer?

We don't hang Zosyn in the PACU much, but they hang it in the OR all the time with LR.

No ... I check Trissel's IV compatability, it says variable, when you click the "variable" link it shows the different manufacturer's.

Cheers

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