quick questions re abx and

[AJpcvRN]

Hey all I have a couple of quick (unrelated) questions. Kind of a survey

1) Do you hang two IV antibiotics (not first doses) at the same time? Multi-lumen central line, several peripherals, compatale Y site, ect. If you do or do not what is your reasoning as to why it is or is not safe?

2) Do you hang chemo on a dedicated line or would Y-site a compatible medication? Again why our why not?

This isn't for school or anything just frequent debates among co-workers. I thought it might be a couple of good EBP topics but alas I can't find ANY research done at all on either question. If you have any suggestions on where to find research please share! Thank all

PS I have already done a scan on the ONS chemo book for the chemo question and didn't find anything

[Karou]

As long as the antibiotics are compatible, I don't know why they shouldn't be able to infuse at the same time through the same line if connected at the y site most proximal to the patient. We have an online resource specifically to check y site and admixture compatibility in IV medications where I work. I will often insert a second PIV if both medications are vesicants and run each (at the same time) through separate lines. You already made a good point about this not being a good idea if the patient is new to both antibiotics. If there were a reaction you would want to be able to determine which one the patient reacted to. So assuming the patient is not new to either and has no known drug allergies to them, I would do as I described.

You can hang incompatible medications at the same time through separate lumens on a multi lumen central line. That's often why a multi lumen central line is even placed. So you can hang incompatible things or vesicants (TPN, antibiotics, blood, ect....)

Sometimes I will have a patient on 2-3 antibiotics, antifungals, lipids/TPN, blood, IV fluid, ect... It can get very tricky. I always double check my comparability at the start of shift and again each time I hang a new medication. When in doubt I call pharmacy to verify.

I don't know about chemo because we have a specialized oncology unit that gets all patients relieving in house chemotherapy treatment. I imagine that like with blood or TPN, that you need a dedicated lumen/line for infusing chemotherapy.

There are oncology/chemo certified RN's here who are able to give you a better answer on that.

[jadelpn, LPN, EMT-B]

Verify anything with pharmacy. They are a world of resource. There are lots of depends,(is this a first dose of anything, for instance) and lots of policies that pharmacy can fill you in on.

Use your resources, and pharmacy loves this stuff!!

[dream'n, BSN, RN]

Chemotherapy MUST run on its own pump. You can add a compatible continuous maintenance fluid BELOW only; close to the patient, as long as it is on its own pump also.

[Here.I.Stand, BSN, RN]

I will run two antibiotics at the same time as long as they are compatible, especially if they are symptomatic of sepsis and need to get that treated yesterday.

I've never given chemo so don't know the answer to the second question.

[Here.I.Stand, BSN, RN]

I should add--if they have renal failure/compromise, I do not run them together, at least not without consulting our PharmD. I figure it's harder on the kidneys to have to process two doses at the same time.

[SierraBravo]

Chemo always infuses alone, unless there is some maintenance fluid that needs to go along with it like NS. Sometimes you will have a multiple chemo preparation all in the same bag, but same thing, it goes alone into one port. As said above, with central lines the ports terminate at different points specifically so that you can infuse multiple, and/or incompatible, things at the same time. I wouldn't infuse 2 ABX at the same time (regardless of whether or not they are going into different ports) if it's the first time the patient is receiving those ABX because if the patient had a reaction to one of them you wouldn't be able to tell which one they reacted to.

[sistrmoon, BSN, RN]

Many chemos have fluids ordered to run with them but also often run alone. Depends on the chemo orders.

I'm fine with running 2 antibiotics together given all the conditions you specify.

Definitely use pharmacy as a resource. I always was certain TPN always had to run alone but we had an adult patient who was covered by peds due to weight with a port and it was cleared to hang a certain antibiotic with it. I've also checked with them when I have a protonix or heparin drip and fluids and can't get a 2nd line. Some of the "dedicated line" recs aren't written in stone.

[ajrpcvrn]

Thanks for all the responses! If I do decide to pursue either of these as an EBP project I will contact the pharmacy (alas, since I work nights our pharmacists are either not helpful or super busy, if I make an actual project out of this I'll have to contact the dayshift PharmDs).

Does anyone have an resources as to why you answered how you did? Mostly I'm curious about the chemo through a dedicated line... I am actually ONS chemo certified and it was never mentioned in the class and it isn't mentioned in the book. I used to work on an inpatient onc floor (transferred to IMC several months ago) and there were two schools of thought; one group said if the meds were compatible then by all means Y them together, the other said never Y chemo (btw there is no hospital policy on this). When I asked group B why they would never Y chemo the answer was basically 'because it's chemo.' No one was every able to give me a good answer. Do any of you have any research justifying the chemo as a dedicated line stance. Thanks!