Drug incompatibility in ICU

Some drugs that I deal with that must be given alone via dedicated lines

mannitol

nipride

sodium bicarb

dilantin

these are just off the top of my head...

Bicarb might be a dedicated line but it's great to hang all the electrolyte riders.

Others requiring dedicated lines:

Xigris

Propofol (technically, there are compatibilities here, but it requires Q12 line changes and you don't want to accidentally bolus it.

Of course when you have a patient on xigris, propofol, bicarb drip, vasopressors, and IV abx, you quickly find that a triple lumen is insufficient access as I learned today! I was checking compatibilities left and right!

Be careful when hanging anything piggybacked into a fluid containing dextrose.

The Pharmacist is your friend. If you're assigned a pt with multiple drips and just a single triple lumen, with more meds (abx & whatnot) due later in the shift, call the Pharmacist. They can be a lot of help in letting you know what's compatible & can be run together, freeing up a line for your other meds.

The best guide for IV drug compatability that I have ever used is the Thomson Micromedex computer program. It actually is easier to use than this online tutorial suggests---you basically just type in the drugs that you want to run into the same line, click once to check the compatability of the drugs, and you get a result in just seconds. We have it installed on our bedside computers at work:

.

http://www.micromedex.com/support/training/online_tutorials/hcs/modules/MODULE_7/s01_01.htm

As previously stated there is more to be considered than chemical compatability when running multiple drips into a single line. The possibility of giving an unintentional bolus of another drug when giving an intentional bolus of another is a big one.

For example, fentanyl and insulin are compatible but if you are giving frequent fent boluses via your pump then you run the risk of inadvertently giving an insulin bolus at the same time.

If possible I start a dedicated peripheral line for insulin gtts. It also works out better if you add those little y-port pigtails to your central catheter and attach each gtt line to a separate port. There are situations where there just are not enough lines to go around and we have to be creative---a second central line would be wonderful but there are times when we simply cannot risk trying to get a second central line due to coagulopathies, for example.

Here's a basic IV compatability chart that might be helpful:

http://ivmedicationcompatibilitychart.com/images/Table%20Intravenous%20drug%20Compatibility.gif

Pharmacists? A great resource....sometimes.

I do love that Micromedex!

As we recently found out at work, printed compatibility charts are outdated and your best resource is to call your pharmacist. If there is question as to compatibility, you can always document "compatibility of X med and X med verified with hospital pharmacist Fred Smith"

The best guide for IV drug compatability that I have ever used is the Thomson Micromedex computer program. It actually is easier to use than this online tutorial suggests---you basically just type in the drugs that you want to run into the same line, click once to check the compatability of the drugs, and you get a result in just seconds. We have it installed on our bedside computers at work:

.

http://www.micromedex.com/support/training/online_tutorials/hcs/modules/MODULE_7/s01_01.htm

As previously stated there is more to be considered than chemical compatability when running multiple drips into a single line. The possibility of giving an unintentional bolus of another drug when giving an intentional bolus of another is a big one.

For example, fentanyl and insulin are compatible but if you are giving frequent fent boluses via your pump then you run the risk of inadvertently giving an insulin bolus at the same time.

If possible I start a dedicated peripheral line for insulin gtts. It also works out better if you add those little y-port pigtails to your central catheter and attach each gtt line to a separate port. There are situations where there just are not enough lines to go around and we have to be creative---a second central line would be wonderful but there are times when we simply cannot risk trying to get a second central line due to coagulopathies, for example.

Here's a basic IV compatability chart that might be helpful:

http://ivmedicationcompatibilitychart.com/images/Table%20Intravenous%20drug%20Compatibility.gif

Pharmacists? A great resource....sometimes.

I do love that Micromedex!

Micromedex is the best!! We have it on all our bedside computers and use it all the time to check drug compatibility.

We have Micromedex on our bedside computers too. Now if only the system worked faster! It seems like our mainframe isn't designed for the load we're putting on it. I had to look up a rarely-used drug a couple weeks ago; it took 16 minutes for the entry from our regional parenteral drug manual to come up. The Micromedex search took another 7 minutes. Thank heaven it wasn't something critical to the patient's survival.

Wow, that IS slow! Ours takes only seconds!