Running multiple IV antibiotics at one time

[sonnyluv]

I'm a new grad training in the ICU. Lately I've been getting into a bit of a debate with my preceptor regarding the administration of two antibiotics (right femoral central line, using different lumens) at the same time. I've consulted the drug book and found that no contraindications exist for giving Vanco and Flagyl at once. It does say that cefipime and Vanco are Y-site incompatible but does not specify if they are safe from different IV sights, for this reason I wouldn't do it. But flagyl and vanco are compatible. Very few people in my ICU do it, but in my nursing school hospital nurses did it all the time.

BTW, the patient has had both antibiotics IV before without reaction, and either way they are both scheduled for 0800, so I end up cutting it close time wise everyday.

Any thoughts on your practice would greatly be appreciated. Thanks ahead of time.

[mpccrn, BSN, RN]

as long as they are not first doses.....go for it

[icyounurse, BSN, RN]

If I had 2 different IV sites I would run them both at the same time, as long as it isnt the first dose and I know that the patient isnt allergic to either one. Sometimes people in the ICU are are on so many drugs/drips/piggybacks/ect that you have to run abx at the same time.

[loricatus]

When in doubt, it is best to call the pharmacist. They are there to guide you in situations like you describe. Be sure to document your call and the response.

[sonnyluv]

Solid advice, thanks everybody!

[Virgo_RN, BSN, RN]

Using different lumens on a central line is not the same as Y-siting through a peripheral line. When you Y-site two drugs, the drugs mix in the IV tubing at the Y junction, prior to getting into the vein. Lumens on a central line are not connected to one another, so the drugs do not mix.

[leslie :-D]

what virgo said.

with a central line, you're good to go.

but just to get your preceptor off your back, it wouldn't hurt to confer w/pharmacy, and write a blurb in your nn's.

leslie

[tryingtohaveitall]

I'm I've consulted the drug book and found that no contraindications exist for giving Vanco and Flagyl at once. It does say that cefipime and Vanco are Y-site incompatible but does not specify if they are safe from different IV sights, for this reason I wouldn't do it.

I know Virgo addressed the fact that different lumens means there is no mixing, thanks for clarifying! I just wanted to say again that the pharmacology book isn't going to clarify if they're compatibile from separate IV sites because it's irrelevant. It's like using two completely different IVs, and thank God for those double lumens when there are multiple meds due! :nuke:

[TriageQueen]

I believe from reading the posts that they were saying you should call the pharmacy, not check your drug book. Pharmacists are wonderful resources to use!

[rph3664]

I believe from reading the posts that they were saying you should call the pharmacy, not check your drug book. Pharmacists are wonderful resources to use!

Thanks for the kind words. We get asked about this sort of thing all the time.

Some of the Godzilla-cillins should not be run with aminoglycosides because even though they are chemically compatible, they inactivate each other. I don't recall right now exactly what they are.

[blondy2061h, MSN, RN]

I run antibiotics at the same time all the time. We have the most wonderful pumps ever though that let us program a bunch of drugs at once and run them all back to back with no further programming. I'll usually hang the drug that runs over the least time first, then schedule any other stuff to go in afterwards. If I start a half hour before the due time, this almost always gets meds in within the hour and a half. If there's no way I'm going to get them all in on time, then I'll run stuff concurrently.

[lpnflorida, LPN]

I frequently call our pharmacists when I have questions. They are very helpful. If timing is an issue. I will then call them and ask if they can possibly change the times on the Mar's for meds . Most often this is not a problem for them. Never be hesitant to call the pharmacy department, they are a wealth of knowledge. If not a pressing issue I do try and not call them during their busiest time of the shift.