IV med precipitate - close call

Nurses General Nursing

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Hey guys, today I had a patient with several IV push meds all due to be given at the same time (lasix, protonix, thiamine). He had NS running at the same time and I pushed the meds through the port closest to the patient, using the NS running as a flush - BIG mistake, lesson learned, won't happen again. Protonix and lasix went through just fine, but once I started pushing thiamine, white thick precipitates formed. I immediately stopped the infusion, threw the tubing away, and used a NS flush before I finished the thiamine push.

I felt HORRIBLE about this and left the hospital thinking - "What if some of the precipitate got through before I saw it and he codes tonight from a clot"? Even though I didn't see any of the precipitate make it through to him. Could this actually cause a clot, or is it more likely to have a med reaction?

What COULD happen if some of the precipitates DID go through his IV line into his circulation? He had a peripheral line going into his AC, not a central line.

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Specializes in pediatrics, ED.

The number one thing I can offer, is you were lucky!!

I advise ALL my new grads to check for compatability prior to giving meds (even the old RN's who haven't given in a while) there is NEVER any harm in checking and reading on compatability. Also you can call pharm. They are not just there to dispense they are there to help!

Use your resources and be ultimately sure!!

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Specializes in Acute Care, Surgery, OBGYN.

Question. Did you manually flush with NS after EACH med administration?? That is BIG thing also to remember.....

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Nope, as I said above, I was just using the pump with NS infusing as a flush...

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What was the incompatability?

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Ages ago, I was preparing a med for and IV push, and was using a 10 cc syringe for better control over the delivery rate, and the required solution (I think it was NS), and the thing turned into jello in the syringe- I was so thankful I hadn't pushed it directly...the only thing I could figure out was that it was a bad ampule of whatever it was (I think it was Valium). I had looked up all of the info re: compatibility, and that was ok (I was a new nurse, and was neurotic about checking info, even if I'd done it before).

i agree with doing a manual flush even through a line, and not always using the closest port to the patient (depending on the med, circumstances- ie- emergency meds, and how many I had to give).

The scares make us better :)

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Specializes in pediatrics, ED.

if you let the IV Fluid be the flush, you could be missing medication. The hub has a little area that meds could hang up in. that's why I say 1. check compatabilities 2. flush flush flush

It's never bad to use at least a 10 mL after each med sometimes it's worth using 20mL but know your meds.

That's the one thing my preceptees always would hate me about. I question about compatabilities, meds, rates etc. it is so easy to make a med mistake that's why I'm super anal about it.

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Specializes in pediatrics, ED.
Ages ago, I was preparing a med for and IV push, and was using a 10 cc syringe for better control over the delivery rate, and the required solution (I think it was NS), and the thing turned into jello in the syringe- I was so thankful I hadn't pushed it directly...the only thing I could figure out was that it was a bad ampule of whatever it was (I think it was Valium). I had looked up all of the info re: compatibility, and that was ok (I was a new nurse, and was neurotic about checking info, even if I'd done it before).

i agree with doing a manual flush even through a line, and not always using the closest port to the patient (depending on the med, circumstances- ie- emergency meds, and how many I had to give).

The scares make us better :)

I was with a nurse of 30 years verifying her dose (Valium is a double check) and I witnessed the Jello in syringe valium. it's gross! We wasted and went about the business with a new vial

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Thanks for the replies guys, but back to my actual question - What COULD happen if some of the precipitates DID go through his IV line into his circulation?

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I would imagine any emboli would lodge in the pulmonary vasculature.

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Specializes in ER.

Valium is one of the few meds that's not supposed to be diluted. It's not soluble in any solution. Per Gahart IV book:

"If dilution is imperative, add dilutions solutions to diazepam, not diazepam to solution; consult pharmacist. Direct IV administration is preferred but can be administered at a Y-tube injection site."

Off subject, but FYI! :D

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Yeah, it's possible for the precipitate to get hung in any vessel...I'm not sure which meds form more solid precipitate vs 'softer' stuff that might eventually dissolve. Scary thought nonetheless.

I'd also be concerned about preexisting illnesses like vessel diseases, diabetes, and interstitial lung disease that would already have vascular pathology, and even small 'chunks' getting lodged- strokes, ischemic limbs, pulmonary scars, etc.

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