Propofol and NS

[ezgreazin]

What's the skinny?

Still a newbie in the ER...some cohorts say no dice to piggybacking a propofol drip on a NS line, my hero/mentor says no problemo.

We all know the IV drugs book state it's contraindicated, soooooooooooooo.

Opinions?

[Altra, BSN, RN]

The bottom line skinny is that you're going to need to follow the policies of your hospital, not the "opinions" of others, unless you can make a case through clinical literature that the policy needs to be changed. And given that the drug insert does explicitly state that Propofol is compatible with D5, LR and some other IVF, but not NSS, it is unlikely that your policy is going to change. If you have questions, see your department's pharmacist or call pharmacy and ask.

[PMFB-RN, RN]

I don't think you mean piggybacking. If you piggybacked it the propofol would be running alone in the line. Yes it's fine to connect propofol into NS lines below the pump. Everybody does it all the time. However as Altra points out unless you have a hospital policy saying that it's OK in your facility you are hanging out there all alone if something happens.

[floridaRN38]

Ask the pharmacy where you work. I wouldn't do it. I had a nurse if a pt a bolus if propo in a NS line and it crystallized. I had to change

Out the tubing. But always ask pharmacy

[turnforthenurse, MSN, NP]

I agree, you can ask pharmacy but you should always follow your facility's protocols and not just go based on what others say. Where I work (and it's our policy), propofol always has its own dedicated line.

[mish_RN]

I agree you can ask pharmacy but you should always follow your facility's protocols and not just go based on what others say. Where I work (and it's our policy), propofol always has its own dedicated line.[/quote']

Yup, same here.

[emtb2rn, BSN, RN, EMT-B]

Yup, same here.

Yep. Another same here. Dedicated line.

[PMFB-RN, RN]

I agree, you can ask pharmacy but you should always follow your facility's protocols and not just go based on what others say. Where I work (and it's our policy), propofol always has its own dedicated line.

*** I am curious how vascular access is obtained in your unit? I assume you can and do place IVs, and PICCs and your providers will place central lines. How is it that you can "always" give propofol it's own line?

Do you admit crash patients from ER or the floors? Do you simply not administer propofol until those patients are lined up? If so what do you use for sedation in the mean time?

Interesting... never knew this.

We regularly co-infuse propofol with NS maintenance or boli... nobody's ever said a word about it, including our clinical druggists who sometimes set up the prop for us when we've got a hot mess going on.

I'm reading in Davis, 12e which says, "Usually administered undiluted. If dilution is necessary, use only D5W."

We're not talking about dilution, though (are we?), we're talking about co-infusions or Y-site compatibility.

Under "Solution Compatibility," it says: " D5W, LR, D5/LR, D5/0.45% NaCl, D5/0.2% NaCl" while saying nothing about any maintenance fluids under "Y-Site Incompatibility."

Its " Y-Site Compatibility" list is extensive and includes NaHCO3, KCl, MgSO4 as well as a lot of abx, pressors, and narcs.

As far as a dedicated line, I see no reason for it... nor is there always such a luxury in the ED.

[Altra, BSN, RN]

From the drug insert: (DIPRIVAN INJECTION, EMULSION [GENERAL INJECTABLES & VACCINES, INC])

Administration with Other Fluids Compatibility of DIPRIVAN Injectable Emulsion with the coadministration of blood/serum/plasma has not been established (see WARNINGS). When administered using a y-type infusion set, DIPRIVAN Injectable Emulsion has been shown to be compatible with the following intravenous fluids.

- 5% Dextrose Injection, USP

- Lactated Ringers Injection, USP

- Lactated Ringers and 5% Dextrose Injection

- 5% Dextrose and 0.45% Sodium Chloride Injection, USP

- 5% Dextrose and 0.2% Sodium Chloride Injection, USP

[MunoRN, RN]

Oddly some manufacturers list it as compatible and others don't, even with the same inactive ingredients/stabilizers. There are many studies involving propofol where it was diluted with NS without any apparent issues. Some solutions aren't listed as y-site compatible because they were found to be incompatible, and others because they were never tested. Our policy specifically allows for y-siting into NS and I'm not aware of any apparent issues with that, but I'd agree this is a facility policy issue (although in general I don't agree with "it depends on you policy" since most of the things we apply this rule to has just one correct answer).