IV Insulin and Cardizem

[NurseBettyICU]

Pt only has 1 IV currently. Insulin gtt infusing. Can another compatible medication be Y'd into this Insulin tubing?

Same scenario, but Cardizem infusing (instead of Insulin). Can another compatible med be Y'd into the Cardizem?

I overheard a nurse say that NEVER should any other med be running with Cardizem or Insulin bc it would push the Cardizem or Insulin into the patient too fast.

Side note: pts are in ICU on continuous cardiac monitoring (Cardizem), BSG is being checked Q1 hr (Insulin).

[JKL33]

^ WADR, part of all of that is understanding the "why" in what you are or aren't doing and this entire discussion is not belaboring anything, it is a discussion of the whys or why nots. For example, yes, we should follow our employers' policies if not contraindicated but at the same time understand why they might have written the policy the way they did. Hypothetically, you could find out that there isn't anything inherently dangerous with running these medications with other medications but the policy was written that way in attempt to (for example) decrease the chances of a nurse picking the wrong pump on which to program a bolus, and bolusing insulin instead of saline. Hypothetically you could also find out that the instruction to "never never ever" do something is simply because it's against the policy, which is not an adequate explanation.

[murseman24, MSN, CRNA]

On 2/26/2020 at 3:02 AM, InHisImage said:

I realize that you aren't entirely disagreeing with me and I also understand that certain circumstances may dictate that certain meds be run together, but I don't care to belabor the point because I believe that enough has been said on the topic for the OP to make her(?) own decision about how to practice; however, there is difference between what is permissible and what is wise.

I will also reiterate that the OP's workplace policies may very well support what she overheard other nurses saying on the subject and that should be the first consideration driving her decision. If there is nothing in writing, IMO the nurse manager should be consulted, not only for clarification, but for CYA...just in case. In the meantime, it is also my opinion that a nurse should err on the side of caution when whenever possible until a definitive answer can be obtained.

This is what's wrong with nursing

[MunoRN, RN]

There's no reason to place another IV because the patient has both Cardizem and insulin infusions. IV's are not without risks, so all you're doing is risking harm to the patient for absolutely no benefit.

You certainly need to consider the dynamics of how your infusions affect each other relative to the characteristics of the medications, and this definitely gets trickier with some medications, but less so with Cardizem and insulin given their relatively gradual peaks and durations of action.