Myers cocktail, IV vitamin infusion

[RNca26]

Hello all,

I have been offered a position at an integrative clinic In California which provides IV Myers’ cocktails and other vitamin infusions. With an order, I know this is something an RN can infuse. My question is regarding mixing the IV bags. At the clinic it appears that the RNs are making the bags by drawing up each vitamin as ordered and adding it to the normal saline bags. Is this permitted? Or is this considered “compounding”? Does anybody else work at a clinic similar to this or a hydration clinic? And if so, how does it work for you? Who prepares the bags or are they ordered?

thank you!

[speedynurse, ADN, BSN, RN, EMT-P]

I think that is considered compounding but some nurses are allowed to do that if they are signed off on the competencies. Some places like stand alone ERs have nurses that get checked off by a pharmacist on compounding because a pharmacist is not readily available.

[amoLucia]

WOW!!! Either things have changed dramatically or else there may be some regulations particularly applicable to Calif or to IV clinics.

On NOC shift in LTC/NH, I freq had to mix IVs when not avail from the pharm delivery or the pre-mixed ones supplied in the IV backup box.

Has the Board of Pharmacy practice been questioned? They prob most assuredly could give you an answer.

NOTE*** I specifically mean the PHARMACY BOARD rather than Nsg Board.

[RNca26]

This is what I found on the CA BRN website. I don’t think mixing antibiotics with a diluent is a problem. I think it’s the mixing of several vitamins into a bag together. I’m attaching a couple of things for review. It’s really making me nervous.

[MunoRN, RN]

In my state we can only add a single medication to a dilutent bag, for instance we can add a concentrated preparation of phenylephrine to a bag of NS to make a phenylephrine gtt bag in the cath lab where we don't stock the pre-made gtts. But we can't add more than one component, and I believe in every state any compounding with multiple accesses of an IV bag must be done with a hood and by someone who's passed their hood-testing.

However this generally applies to medications, the components you're talking about aren't classified as a "drug" because they have no recognized valid medical use, which is both good and bad. You're essentially mixing substances for recreational intravenous use.

State laws and regulation vary widely on this, in many states this is essentially unregulated. In my state the BON has come out and basically called this reckless behavior for an RN to engage in since you're putting patients at risk without any offsetting potential benefit, so they've warned they'll be quick to pull your license if anything goes awry, medical 'spas' in my state are largely staffed by unlicensed personnel 'overseen' by a physician. You may want to also check into what Liability Insurance coverage is available first.

[RNca26]

All good information. Thank you for those responding. The potential employer is an internal med physician who also has studied holistic medicine. It’s not a med spa type place. There are always providers there seeing patients for medical problems. I’m not sure if that makes any difference. I just wanted to add that.

[amoLucia]

Am finding this all very interesting, but still clear as mud to me!

No wonder OP has such concerns.

I'd still ask the Board of Pharmacy for an opinion.

JMHO (And glad I've retired.)