NTG IV and compatability

rollingstone · May 8, 2004

Heparin gtt and Nitro gtt are compatible. Morphine IVP can be given too with Nitro infusing. If you're confused after consulting an up-to-date drug reference give your friendly pharmacist a buzz. They're a great resource.

gwenith, BSN, RN · May 8, 2004

Bottom line - don't mix anything if you have any options. it's a GOOD rule. But when you gotta then you gotta.

One of the things that you have to consider is maintaining a steady flow of the drug.

Found this

http://www.cs.nsw.gov.au/rpa/neonatal/html/meds/gtn.htm

http://members.ozemail.com.au/~jamesbc/pages/drugs/122.htm

Trauma Columnist · May 8, 2004

In our hospital the official policy is NTG runs by itself. However, (there are always caveats) if no further venous access is available, then we run NTG and Heparin together. We do it fairly frequently due to the fast door to cath lab that we do.

NYCRN16 · May 10, 2004

If my patient is getting a nitro gtt and heparin gtt, I will start another line in order to give them. This is the easiest solution in order to give them. Interestingly enough, a lot of my patients who come in for GI bleeders also are having MI's, and a 3rd line is started to accomidate the protonix gtt!

Pete495 · May 10, 2004

Nitro actually is compatible with many things, such as Dopa, dobut., epi, vasopressin, primacor, cardizem, heparin, etc. check your compatibility chart, or drug book. course, usually this is when we're running things through a central line. If I'm running it peripherally, I always have another site mostly because you may need to give something else IV, esp. in a hurry since NITRO is a cardiac drug. It's just safe to have another site. Our hospital policy says we must always have an available site in critical care.

newfloridaRN · May 11, 2004

On all of our Acute MI patients, we usually run NTG with Saline and Heparin....If ordered that is. They are compatible.

GDog7NYC · May 12, 2004

When a patient comes into the ED and you suspect ACS related chest pain, it's usually a good idea to start at LEAST 2 peripheral lines immediately. If you have the opportunity for a third, then go for it! That would solve your Nitro/Heparin dilemma (but Nitro and Heparin are compatible for at least 24 hours so by the end of that time frame, your patient should be out of the ED). The other thing is, if you have to push IV Lopressor or Morphine or start GP IIb-IIIa agents such as Integrilin or Reopro, or other drugs which will require a dedicated line, then you've got that base covered as well. :)

veetach · May 12, 2004

If Nitro is compatible with the drug, I run them together. Especially Heparin.

zambezi, BSN, RN · May 13, 2004

We run ntg with other compatible drugs all the time. As pete stated, I try to keep my vasoactives together so if I have to flush fast for whatever reason, I have an extra line to do it in. I try to keep meds seperated as much as possible but I mix and match per compatibility when necessary. I agree with what pete mentioned about have and extra site. Sometimes that is not always possible but I always try to have a site when I am running something that I can interrupt is necessary.

rnmaven · May 13, 2004

Hi everyone. I have a question about Nitro IV. In my Davis' Drug guide it says that the manufacturers don't recomend mixing or adding anything to it or running it with anything else. I have also heard other RNs saying that nothing gets along with NTG. But the Davis' also lists some Y-site compatabilities (amiodarone, dilitiazem, dopamine, epi, famotidine, fentanyl, lasix, mso4, theo, propofol, and many others). I'm confused, what does everyone out there do??? Thanks!

Dear JaimealmostRN,

I wish I still had a hardcopy of the article on IV heparin and NTG but it's been alot of years since I read the article in the AACN journal for critical care. As I remember it, the findings were that if you run NTG and Heparin together (at the Y-site) there is a problem with obtaining accurate PTT readings. Therefore, you will see that most policies require a separate line for NTG infusions.

Now, in response to some of the other responses I read on this discussion, let me say that some of your best sources for this information comes from the drug manufacturers. I worked for Abbott Hospital products and we did alot of drug studies with various pharmacy schools on this topic because we sold infusion pumps that utilized cassette technology where drugs "mixed" in the cassette during infusion of multiple drugs.

I also was a manger for INTEGRILIN and I can tell you that the company invested money in documenting compatibility of Heparin and INTEGRILIN as these two drugs were commonly infused together at the Y-site.

Now to clarify some of the confusion regarding drug compatibility data.....You will see information regarding compatibility in solution......in other words when drugs are mixed in the same container and you will see data on compatibility at the Y-site. When you look at the information comparing these types of drug compatibilities it all comes down to the following concept: How long do the drugs "mix together" in the same container or line. If you run two drugs together at the Y-site, depending on their respective infusion rates and the priming volume of the IV tubing, these drugs may actually mix (or touch each other) for varying lengths of time. Compatiblity be it physical or chemical is related to drug-mixing time.

The long and short of it is this........if your hospital has a good Pharm.D on staff, they can research this information for you. If you want to work on changing policy, you can contact drug companies drug information departments and they will be happy to supply you with the information you require.

Hope this clarifies your question!

:)

rnmaven · May 13, 2004

Hi everyone. I have a question about Nitro IV. In my Davis' Drug guide it says that the manufacturers don't recomend mixing or adding anything to it or running it with anything else. I have also heard other RNs saying that nothing gets along with NTG. But the Davis' also lists some Y-site compatabilities (amiodarone, dilitiazem, dopamine, epi, famotidine, fentanyl, lasix, mso4, theo, propofol, and many others). I'm confused, what does everyone out there do??? Thanks!

Just a few more thoughts on drug compatibility. One of the many things I see working in critical care is that nurses seem to think that they can Y-together drugs via an extension set that is attached to the patient's IV angiocath. I see them running one drug into one pigtail of the extension set and another drug into another pigtail......yet those two drugs are not compatible. When I bring this to their attention they say that they aren't mixing for very long so it's OK.

Now, if you're working in a small ICU where you just can't get a central line and the 90-some year old patient just doesn't have a vein to be had.....I guess you gotta do what you gotta do. But I'm afraid that many nurses just aren't thinking when they do this kind of set up.

I had another critical care article where they did radiographic studies of simultaneous injections of Dilantin and Calcium via two separate ports of a triple lumen catheter. They documented via x-Ray the "white cloud" of drug precipitate that entered the bloodstream when these two KNOWN incompatible drugs were injected. The reason this occurred is because the two ports of the TLC are close together and when the drugs exit into the bloodstream they "touch" and created the physical incompatibility.

So remember.......just because you don't see the incompatibility don't think it's not happening!