Neosynephrine compatibility problem

Daytonite, BSN, RN · Apr 12, 2007

Neo-Synephrine (phenylephrine hydrochloride) is definitely incompatible with Diprivan (proprofol). It may potentiate the effects of the Leophed. You'll need to run it through it's own port of the CVC or have another IV site set up.

RedCell · Apr 12, 2007

phenylephrine is compatible with norepinephrine.

http://www.vhpharmsci.com/pdtm/monographs/phenylephrine.htm

if you are still worried you can always put the diprivan with your crystalloid solution or heparin infusion.

http://www.vhpharmsci.com/pdtm/monographs/propofol.htm

cardiacRN2006, ADN, RN · Apr 12, 2007

Yeah, I usually run my pressors together...

Daytonite, BSN, RN · Apr 13, 2007

According to my resource (page 1024-5 of 2007 Intravenous Medications, 23rd edition, by Betty L. Gahart and Adrienne R. Nazareno) there is "Conflicting Compatibility Information" available regarding propofol (Diprivan) and phenylephrine hydrocholoride (Neo-Synephrine). They do not list the specific source. I would not chance it and mix the Neo-synephrine with the Diprivan in the same line. I was a CRNI for many years. When you have multiple drugs infusing it is always safer to isolate and infuse them through their own separate lines. So much is unknown about the physical and chemical incompatibilities of combining drugs together. One of the nice things about central lines with multiple ports is the convenience of being able to do this.

CRNI-ICU20 · Apr 13, 2007

I would start a separate line and run the Diprivan peripheral, as opposed to running the Neo peripheral....vasoactives are usually very harsh on peripheral veins and the chances of extravasaton or phlebitis is high....Diprivan is okay to run peripheral...and it's beter like the others said to run separate lines for your pressors and such.....

Why was D51/2 running wide open??? I don't think I have ever seen that....I have seen LR or NS full open....but dextrose full open isn't wise....

This can really cause some metabolic probs. in septic patients....and it is really hard on kidneys and brain tissue at a full on rate...

I wouldn't put a titrated drug into a line where it could be accidently bolused into the bloodstream via a fast running IV line, or a transduced line, like a cvp line....

I am curious about the primary IV rate, and why.....

meandragonbrett · Apr 13, 2007

I would probably start an A/C and run the D51/2NS via the PIV. We run propofol on a lumen by itself and I'd put the levo in another lumen.

Why does this pt. have D51/2NS wide open? What was wrong with this patient, or is it a hypothetical patient?

jayjaykay · Apr 13, 2007

Thanks for all of your responses....

This was a hypothetical patient that my instructor came up with.

Jayjaykay

TraumaGirl1018 · Apr 17, 2007

this may be a silly question, but if you have a triple lumen port, does EVERYTHING running through all three ports have to be compatible? Or say, can you run Neo through one port and Diprivan through another safely?

Daytonite, BSN, RN · Apr 17, 2007

when you have a triple lumen catheter you want to use your lumens wisely. a lot depends on what medications and iv fluids the patient is getting. you can always run just one drug through one line of the catheter. the largest port is often kept heparinized for blood sampling, but it doesn't always have to be done that way. if the patient has tpn infusing, it has to be infusing on it's own line because nothing else can be piggybacked and run concurrently into the same line as tpn. when you do run things together in the same line, yes, they have to be compatible. one of the best illustrations of this is to try to run a piggyback of dilantin through a line that has d5w infusing on it. you will actually see the physical precipitate that forms in the tubing before some of the precipitate makes its way to the iv cannula where it clogs it up and the iv stops running. what you can't see with many drugs is how incompatible drugs interact with each other and cancel out the effect of each. you also need to be aware of where the distal holes are on these catheters. in some instances you want some of your more irritating drugs to be infusing through the ports that are most distal where they will encounter more turbulence in the atrium where they enter the body (if that is where the distal end of the catheter is located). it is possible for a subclavian vein to develop phlebitis from irritating drugs infusing into it. there are a lot of factors you need to consider with iv infusions and the iv devices that are being used.

CRNI-ICU20 · Apr 18, 2007

Most Infusion Therapy protocols are now adopting a heparin free protocol, because of the increased incidence of HIT and allergic reactions to heparin. You can infuse incompatible drugs IV through a central line concurrently, that is why a triple lumen was invented.

here is a good study done in vivo on just this subject, and the conclusion was that there was no evidence of precipitate or clogging problems as the above poster mentioned....

I have used T-lumens, Swans, Groshongs, Hickmans, etc. for my whole nursing career....and as long as you think before you plug in your drugs, you should do just fine....just don't run incompatibles IN THE SAME PORT...

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=29014

Background:

Multilumen catheters are commonly used in critically ill children. Their use, however, is associated with significant morbidity. We studied the simultaneous administration of incompatible drugs using a new triple-lumen catheter with decreased length and port to port distances.

Methods:

Ten domestic swine, 10–20 kg in weight, were divided into two groups of five. Total parenteral nutrition was administered through the distal port and phenytoin was administered as a bolus and as an infusion in each group. Samples were taken from two sites during the bolus and at 1, 5, and 15 min during phenytoin infusion. Histograms were generated for particle size and concentration. Samples were also examined under the microscope for particles.

Results:

Histograms of particle size did not show any alteration of the histogram that would suggest particle size > 2 μm in diameter in the study or control samples. No particles were identified by phase microscope, light microscope, or Wright stain smear.

Conclusions:

The use of a triple-lumen catheter with a distance of 0.4cm between the proximal port and the medial port and 1.3 cm between the medial port and the distal port, for the in vivo simultaneous administration of incompatible solutions does not result in precipitates large enough to cause adverse clinical effects.

It is helpful to have some peripheral lines if possible, for the less abrasive IV solutions, ie a normal saline tko with maybe intermittent pushes and less caustic antibiotics....and leave the central line open for blood draws, TPN, and IV pressors or blood administration.

I hope this answers your questions....

CRNI