I'm a Block 3 nursing student just starting to do IV fluids. Yesterday a patient had fluids running and I had to start a Flagyl piggyback. I had to check compatability of that fluid, D5 1/2NS 20KCL, with the Flagyl. I first looked in the IV drug book and there was no info on that fluids being okay with that drug or not. Then I looked on the hospital med check website and there was no info either. Finally I called pharmacy. After I asked the question, the pharmacist said, "I can tell you it will be fine, but I'll look it up just to verify." After a long time on hold the pharmacist said, "My source said it's not recommended to combine those two because of the potassium is not compatible with Flagyl." The instructor was perplexed and said it was standard practice to run the Flagyl with the fluids, but since the pharmacy said not recommended, we should d/c the fluids and start a new primary line to run the Flagyl, then restart the fluids. The nurse I was working under said that it was okay to run the two together and gave the go ahead and said if I was not comfortable with it, she would do it for me and have it be her responsibility. We went ahead and ran them together.
I felt stuck between a rock and a hard place-- with the pharmacy saying one thing and standard practice being another thing. WWYD? And if there was an adverse reaction, would I be blamed for it for going ahead and running those fluids together, or would it be understood that it was common practice so it was okay that I did it? What should I document if I decided to run them anyway?
Well, considering a couple letters sometimes means the difference between one drug and another very different drug, I think spelling drug names, if nothing else, is vitally imporant.
HOWEVER, I get that this is a discussion board, not a hospital, so I understand it might have seemed a little overbearing to have your spelling corrected here. But if you spell it right here and elsewhere, you'll spell it right when it counts.
I don't care if 50 nurses with 20 years of experience each tells me it's ok.
If pharmacy says no, and you do it and something happens, you are SOL.
At our hospital, that is the end of story. Never even up for discussion.
You'll find when you start working on your own that tons of nurses do things because they have seen it done or it USED to be an accepted practice.
For example, I see nurses push morphine with a fast IV push all the time and swear there is nothing wrong with it...but if you check the drug book, it calls for a slow IV push of 5 minutes...that is just a quick, easy example, but you see what I mean.
First off, I wouldn't run anything piggyback with potassium because an accidental bolus of potassium will stop your heart. Also, potassium is one that frequently doesn't play well with others.
Having said that, I think if the concentration of potassium in a liter bag is small (say, 20 meq's), it's probably not going to matter. I still wouldn't do it, though. It's just not worth the risk to the patient, and if I find out you did it to my mother you're not going to have to worry about whether or not harm came to her. You'll have to worry about me finding you.
For example, I see nurses push morphine with a fast IV push all the time and swear there is nothing wrong with it...but if you check the drug book, it calls for a slow IV push of 5 minutes...that is just a quick, easy example, but you see what I mean.
First, I agree. If pharmacy says "No dice," then do as they say.
Second, and off-topic, I've never seen anyone push morphine over 5 minutes. Slow IVP over 1-2 minutes, 3 MAYBE if the person has had a lot already or is very sensitive, but 5 minutes? Never seen it.
Gut check. Do you think your preceptor will really stand in front of the judge and say "Yes sir, I told her to hang it that way after pharm said no. I'll give up my license, she can have hers."
Specializes in multispecialty ICU, SICU including CV.
Looked this up on my lunch break and my online drug guide at work (Micromedex 2.0) says that metronidazole in a 5mg/ml concentration and potassium in a 10mEq/100ml concentration (a lot more concentrated than 20mEq/L) is compatible. I don't know where your pharmacist is getting his/her information.
We always run piggyback antibiotics with IVF that has KCl in it. The bolus of KCL that you would get is tiny -- whatever most of the volume of tubing is -- 10cc at most, and it's not a fast flush (probably 100-200cc/hour at most if you are running flagyl. I believe it is generally over 1 hour.) I don't think there is any risk of cardiac arrest to the patient at all.
Can I just point out that you spelled "important" incorrectly?
Not the way to go
when chastising someone for a typo;)
Well, considering a couple letters sometimes means the difference between one drug and another very different drug, I think spelling drug names, if nothing else, is vitally imporant.
HOWEVER, I get that this is a discussion board, not a hospital, so I understand it might have seemed a little overbearing to have your spelling corrected here. But if you spell it right here and elsewhere, you'll spell it right when it counts.
Now you've got that off your chests, please stay on topic. I'll delete any further off topic posts.
Thank you
In the UK if pharmacy so no then I wouldn't mix the two drugs. If your unsure then best go with a cautious approach and listen to your experts
Looked this up on my lunch break and my online drug guide at work (Micromedex 2.0) says that metronidazole in a 5mg/ml concentration and potassium in a 10mEq/100ml concentration (a lot more concentrated than 20mEq/L) is compatible. I don't know where your pharmacist is getting his/her information.
We always run piggyback antibiotics with IVF that has KCl in it. The bolus of KCL that you would get is tiny -- whatever most of the volume of tubing is -- 10cc at most, and it's not a fast flush (probably 100-200cc/hour at most if you are running flagyl. I believe it is generally over 1 hour.) I don't think there is any risk of cardiac arrest to the patient at all.
This is completely right on. A lot of compatibilities have to do with concentration. We use Micromedex as well and it's a godsend. I also want to second dispelling the worry about bolusing K+ when the concentration is as minimal as 20 or even 40 mEq/L.
For perspective: Flushing 5 mL of maintenance fluid with 40 mEq K+/L delivers 0.2 mEq of K+. That probably wouldn't even stop a gerbil's heart.
Specializes in Psych/CD/Medical/Emp Hlth/Staff ED.
Flagyl and potassium chloride are compatible, we have 3 different IV compatibility references all of which state specifically that they are compatible. Pharmacists are a great resource and we should definitely take their suggestions into consideration, but we shouldn't blindly follow their instructions either, we are ultimately responsible for what we do.
Lucky0220
318 Posts
Metronidazole