IV compatibilities - how to deal with them?

[Lazy Nite]

Hey peeps

Does anyone know what type of things to look out for if you have:

Pereripheral line: Drug A + B

Centeral lumen: Drug C

Central Y-site: Drug D + E

Drug A is vesicant
Drug B is running at the max concentration
Drug C is a continuous infusion
Drug D is TPN
Drug E is an Antibiotic

Any suggestions please??? Anyone???

[Lazy Nite]

36 views, but no replies…!

Does this mean no one knows anything about this topic or no one is interested…..?

I have an assessment on this soon…..would really help if someone could help me out....as I always try to help others on this forum

Anyways…..thanks a lot

[Emmz]

I'm not sure but have you tried going into MI at your hospital and asking what IV reference sources they use? Hopefully you have a nice MI pharmacist who can help

[Shwampa]

a) High risk of extravasion and tissue damage. You need to reduce the rate of perfusion Cookie Absent

b) Continous perfusion through a central lumen catheter will draw back blood due to differential of pressure. You need intermittent perfusion.

c) Not all antibiotics are compatible with TPN and to avoid the risk of precipitation of the ATB you need a different site for injection and avoid the Y site.

Those are the answers, but you need now to do your part and find the references and please avoid "bossy" avatars or no one will help you.

[Lazy Nite]

Emmz and Shwampa

Thank you so much for your replies….

I’ve been asked the question above and my response to it was:

1. I would need further information about the drugs given. Such as the concentration being used, the rate, what other lines are available…etc
2. Search the relevant sources: such as the EMC website for the SPC, the hospital IV guide, the national IV guide, Trissels (handbook of injectable drugs).

However, I was asked to give the answer straightaway…but without looking at the sources….I would find it difficult to know the answer from the top of my head.

What I wanted to know…if there were things to look out for before carrying out the main research……

a) please avoid "bossy" avatars or no one will help you.

What do you mean by that?

[Band6]

Wotcher Lazy Nite,

Interesting bunch of compatibilities there!

A+B - I would be looking at thrombophlebitis and extravasation (spelling?!). Vesicant drugs such as vincristine/vinblastine can do nasty things if the line tissues. Be aware of your hospitals extravasation policy/kits. Something running at maximum rate plus a vesicant I would imagine would cause extra irritation in the vein. I would also be looking at chemical incompatibilities between the two.

C - not really sure! Maybe issues around changing the line?

D+E - As above, the salts of different antibiotics can sometimes cause the emulsion of a ready made TPN base bag to crack, due to the actions of the different ions (eg K+, Na+). I've always been told that you should never run anything through the same line as TPN (or PN as we're supposed to call it now!!) due to compatibility problems and the risk of contamination. A multi-lumen central line should overcome this problem.

The injectable drug guide, Trissel, hospital training packs for PN etc are good sources. Also ask your oncology pharmacist regarding extravasation.

[Lazy Nite]

Hey Band6….I’m well…how are you?

What have you got planned for your Band 7 post?

Thanks for your reply…that was excellent! I can always count on you!

For chemical incompatibilities between the two….do you mean ‘Drug interactions’ and checking the ‘Diluents are compatible’???

[Band6]

I'm very well thank you! I'm applying for a Band 7/8a oncology and haematology job in a different hospital. It's the only band 7 job in the area so I reckon I'll be competing against a few thousand other applicants!

For incompatibilities, I mean chemical incompatibilities between the two solutions - diluents, active ingredients, anything!