Question about IV push and incompatible med

What medication are you giving that interacts with Pitocin?

We always have saline locks connected to the tubing but our patients pretty much always have fluids running, particularly lactated Ringer, and are never really saline locked in our L&D unit. And we have lots of patients on Pitocin for induction/augmentation as well so these two fluids are running piggybacked together (Pitocin piggybacked into the lowest port on the LR line). I am not really asking with any particular medication in mind that I would be giving with Pitocin...I gave Benadryl IV push the other day to a patient on LR and Pitocin. I gave it in the next port up on the LR (since the lowest port was piggybacked with Pitocin) with the fluids running. I know it is compatible with Pitocin anyway, but I just started thinking of what I would do if I had to give something that were incompatible with Pitocin. I just don't want to make a med error and was thinking it through. I thought if I had to give something incompatible with Pitocin but compatible with LR, I could give it in the next highest up LR port with the LR continuing to run and just stop the Pitocin and let the LR run for a minute, then restart the Pitocin, right? I guess I was thinking the Pitocin and hypothetical incompatible med would mix when they could potentially meet at the Y-site nearest the patient, when they run into the saline lock, since it would not be given in the lowest port closest to the patient. Was wondering if I should just unscrew everything and give the IV push right into the saline lock (first flushing with 10 mL NS flush, giving med, then flushing with NS again), then reconnect the tubing. Anyway, I am just a new nurse and thinking about things so I don't make a med error. Hope all this makes sense.

Pitocin is a synthetic hormone that the body makes naturally, so I'm honestly having a hard time thinking of any med that would be both incompatible and appropriate to give a pregnant woman while in labor or postpartum. It's not a scenario that I've come across in all my years of nursing. Remember if she's in labor or just postpartum not only is she getting oxytocin through her IV but she is also producing her own naturally - so a medicine that would not react well to the Pitocin in the IV site would most likely generate an adverse reaction once in her bloodstream to my way of thinking.

That makes perfect sense, actually--I never thought about it like that! As I said, I just started L&D and nursing and I guess Pitocin was a bad example to use. I know it is a high risk medication so just assumed there would be meds that would not be compatible with it and was using it more as a hypothetical since we give it a lot.

Usually, if I am giving a continuous infusion of something other than a standard fluid, I will have a second site ready to go, and either have NS running at KVO, or keep it locked off. I run into this mostly with heparin and insulin - usually these pts come to my floor from ER with at least 2 IVs in the first place though. I will NEVER EVER try to push something in the same site as heparin or insulin - too many possibilities for error, even if I'm extra careful about flushing before and after.

Alaris tubing contains 16mls of fluid, from the air sensor to the end of the line. If you pause the incompatible med and allow enough time for the compatible fluid to flush the line entirely, you'd be good to run the new med. Follow the same procedure afterwards to ensure the line is clear. If you're nervous, running 20mls won't hurt. I give chemo all the time and this is the method we use to ensure the patient receives all the medication in the line. I'm a hem/onc nurse so I don't know nothing about birthing babies or pitocin admin.....but I am a pro at navigating line compatibility problems!

If your LR is infusing at say, 100mL/hr, then it would take 12 minutes to let 20mL run through. I've never administered Pitocin, but I'm gonna guess that it's not a med you can pause for 12+ minutes.

The solution is for any continuous drip like this, to have a dedicated line. Start a second IV to push your intermittent meds.

As far as reactivity, some meds can have reactions to preservatives or other ingredients; since oxytocin is endogenous any rxn would likely be between what's added not the active ingredient; or can be a question of concentration (e.g. diphenhydramine and solumderol form a precipitate if mixed undiluted but are both happy together in a 100mL premed bag). Unless you have a reason for using the proximal port for your pit IVPB, what about the distal port? Then you are free to pause the secondary, give your push close to the patient with no worries flushed with a short LR bolus on either end then resume the pit gtt in 5 minutes or less depending on the push med