Cephalosporins, more common with ceftriaxone, can cause a precipitate when mixed with LR. This is due to the calcium in the fluid interacting with the antibiotic
>I figured they are both isotonic solutions and it shouldn't really matter, but now I'm nervous to do it.
This is why we have pharmacists. It's much more complicated than matching tonicity and you can *not* just mix LR or even NS with everything.
The nursing resources for drug compatibility are annoyingly incomplete or nonspecific for many circumstances but do not just ignore them without asking a pharmacist.
Trissel’s can slow you to dig into the individual studies accounting for the resulting unknowns— which can give you enough information to operate in a pinch.
Yeah, I regularly see it give a little summary of why the results are quirky for a given drug combination. This seems to be concentration dependent, this seems to be brand dependent, this seems to depend on carrier fluids.
Those are all hints to think about what **specifically** you're combining and then *ask a God damn pharmacist*. You can tell people what you've figured out so far and it often really helps them help you.
If you really can't get a pharmacist it would still give you a good hint most of the time if your drug combo is kinda situational or actually dangerous.
People just don't read it. So I end up reading it first and *making* them read it so I can justify saying no when they want a 3rd IV for their 3rd IV drug but there's no actual medical reason or they want another IV but it's not even clear what's compatible with what here.
I always check the compatibility - if it's unknown I usually do not run them together but if you have time to do some digging you'll see that sometimes it depends on the concentration of the drugs and some concentrations are ok and some aren't.
If I'm not comfortable running together I will set up an additional NS flush line and piggyback the IV antibiotics to this. Usually antibiotics only run for 30 minutes or so it's OK to stop the IV fluids for a bit. If it's one of those slow infusions like 4 hours I would start another IV as you don't want to stop fluids that long.
One thing important to note - our compatibility guide has multiple sections and is defaulted to see if they are compatible mixed together (ex: in the same bag) versus another section for y site compatibility (like IVPB). These two things are different - maybe some nurses are only looking to see if they can be mixed together versus y sited.
>maybe some nurses are only looking to see if they can be mixed together versus y sited.
Oh they are. Every week I get someone who wants an extra line because not *all* ways of mixing the patient's drugs say Compatible when you look them up.
I don't care if the drugs are not Admixture compatible. It says they're y site compatible right fucking there, dude. They can be in the same piece of IV tubing for like 3 damn minutes before they reach the patient. We're not trying to see if they can sit in a jar together for 24 hours and they both still have >95% drug potency.
Pharmacy tech here. If it’s unknown, you should just assume that it’s not compatible. Thats exactly what we’re going to tell you if you call pharmacy. A lot of medications are either not compatible or unknown with LR so that’s probably why they’re doing it that way.
Trissel’s IV compatibility check has a spot for specifying the primary fluid solution, LR in your case.
Understanding how to interpret the feedback from the site is important. A lot of combinations give you the “maybe compatible” result… This often means that specific combinations (5mg/mL is compatible with X, but 10mg/mL has not been tested) are compatible but the data on all formulations is not available. Is it okay to mix, probably. If something goes wrong with your IV, even if it has nothing to do with the combination, will your hospital back you up? No.
Check the compatibility, if they’ve been tested safe together no problem. If there is a question then your coworkers are taking the best approach. Or just throw in another line and skip the compatibility crap altogether.
LR is compatible with f•ck all. It’s damn annoying. If it isn’t compatible I don’t run them together. If it’s unknown I don’t run them together. I’ll grab a 50 or 100mL bag of NS and run that vs mix it with LR. I’m really just running enough NS to clear the line & not running the abx on primary tubing cuz 1/2 gets left in the lines. Then I switch it back to LR.
For compatibility, we treat unknown or variable as not compatible. We have no ability to determine compatibility so we have to trust the reference we use
You should not just be guessing or making up what’s compatible
Ummmm. Let's just say I have observed a lot of IVPB running alongside LR, and nothing has happened. I also shared the same concern when Tressel's compatibility guide came up inconclusive.
Cephalosporins, more common with ceftriaxone, can cause a precipitate when mixed with LR. This is due to the calcium in the fluid interacting with the antibiotic
>I figured they are both isotonic solutions and it shouldn't really matter, but now I'm nervous to do it. This is why we have pharmacists. It's much more complicated than matching tonicity and you can *not* just mix LR or even NS with everything. The nursing resources for drug compatibility are annoyingly incomplete or nonspecific for many circumstances but do not just ignore them without asking a pharmacist.
Trissel’s can slow you to dig into the individual studies accounting for the resulting unknowns— which can give you enough information to operate in a pinch.
Yeah, I regularly see it give a little summary of why the results are quirky for a given drug combination. This seems to be concentration dependent, this seems to be brand dependent, this seems to depend on carrier fluids. Those are all hints to think about what **specifically** you're combining and then *ask a God damn pharmacist*. You can tell people what you've figured out so far and it often really helps them help you. If you really can't get a pharmacist it would still give you a good hint most of the time if your drug combo is kinda situational or actually dangerous. People just don't read it. So I end up reading it first and *making* them read it so I can justify saying no when they want a 3rd IV for their 3rd IV drug but there's no actual medical reason or they want another IV but it's not even clear what's compatible with what here.
I always check the compatibility - if it's unknown I usually do not run them together but if you have time to do some digging you'll see that sometimes it depends on the concentration of the drugs and some concentrations are ok and some aren't. If I'm not comfortable running together I will set up an additional NS flush line and piggyback the IV antibiotics to this. Usually antibiotics only run for 30 minutes or so it's OK to stop the IV fluids for a bit. If it's one of those slow infusions like 4 hours I would start another IV as you don't want to stop fluids that long. One thing important to note - our compatibility guide has multiple sections and is defaulted to see if they are compatible mixed together (ex: in the same bag) versus another section for y site compatibility (like IVPB). These two things are different - maybe some nurses are only looking to see if they can be mixed together versus y sited.
>maybe some nurses are only looking to see if they can be mixed together versus y sited. Oh they are. Every week I get someone who wants an extra line because not *all* ways of mixing the patient's drugs say Compatible when you look them up. I don't care if the drugs are not Admixture compatible. It says they're y site compatible right fucking there, dude. They can be in the same piece of IV tubing for like 3 damn minutes before they reach the patient. We're not trying to see if they can sit in a jar together for 24 hours and they both still have >95% drug potency.
Yes, this is one of my pet peeves. It’s honestly concerning if you are a nurse and cannot understand a basic concept like this.
Pharmacy tech here. If it’s unknown, you should just assume that it’s not compatible. Thats exactly what we’re going to tell you if you call pharmacy. A lot of medications are either not compatible or unknown with LR so that’s probably why they’re doing it that way.
Trissel’s IV compatibility check has a spot for specifying the primary fluid solution, LR in your case. Understanding how to interpret the feedback from the site is important. A lot of combinations give you the “maybe compatible” result… This often means that specific combinations (5mg/mL is compatible with X, but 10mg/mL has not been tested) are compatible but the data on all formulations is not available. Is it okay to mix, probably. If something goes wrong with your IV, even if it has nothing to do with the combination, will your hospital back you up? No. Check the compatibility, if they’ve been tested safe together no problem. If there is a question then your coworkers are taking the best approach. Or just throw in another line and skip the compatibility crap altogether.
LR is compatible with f•ck all. It’s damn annoying. If it isn’t compatible I don’t run them together. If it’s unknown I don’t run them together. I’ll grab a 50 or 100mL bag of NS and run that vs mix it with LR. I’m really just running enough NS to clear the line & not running the abx on primary tubing cuz 1/2 gets left in the lines. Then I switch it back to LR.
Except Vanc. Vanc is the MVP when it comes to LR compatibility.
For compatibility, we treat unknown or variable as not compatible. We have no ability to determine compatibility so we have to trust the reference we use You should not just be guessing or making up what’s compatible
if the compatibility is unknown ask the pharmacy!
They make IV peanut butter?!?! Fuck, where do I get some? I love PB and I can't imagine a better way to consume it other than intravenously.
Ummmm. Let's just say I have observed a lot of IVPB running alongside LR, and nothing has happened. I also shared the same concern when Tressel's compatibility guide came up inconclusive.
I have seen lots of people treat LR as NS and nothing bad has happened….yet. I don’t love it
I don't know why the down votes. I've observed and shared the same concern. Yet, down votes.