Nurses and pharmacists caring for patients on IV medications need to know how to check for compatibility, interpret the compatibility reference, and then apply their findings in real life.
Table of contents
- What kind of access does your patient have?
- What diluent or fluid are you supposed to reconstitute or flush with?
- How long do you need to run each infusion for?
- Are you checking for an admixture or a piggyback?
One of the most common references for making sure that two or more medications can be administered in the same line, in the same syringe, or combined in the same bag is known as Trissel’s. It’s a book, also available as an online database, titled “Trissel’s Stability of Compounded Formulations” and written by Lawrence A. Trissel. But the book is just words and tables without your clinical knowledge to interpret it. You can think of any two parenteral medications and find the page, but the book alone doesn’t have the whole story.
Here are some considerations when checking IV compatibility that you won’t easily read in a nursing or pharmacy compatibility reference:
What Kind of Access Does Your Patient Have?
One item you will need to know is how many lines your patient has, what kind (PICC, port, etc.), where they are, and what gauge. We are going to assume they’re all working and not showing any signs of infiltration or extravasation. And while you’re at it, who put the line in (was it pre-hospital?) and when. The who and when don’t matter for checking IV compatibility but it’s part of the patient’s story if you’re trying to get the whole clinical picture.
You can find this information by checking the chart, asking the nurse, or just looking at the patient. For example, a chest port looks completely different than a 20 gauge peripheral in the left antecubital.
Why is compatibility even important? The biggest complication we are trying to prevent is precipitation or really any physical or chemical incompatibility. Precipitation is commonly described as when two or more substances interact with each other and form a solid. A 2009 article from American Journal of Health-System Pharmacy explains that precipitation is “likely when oppositely charged, organic drug ions that contain aromatic rings are combined in relatively strong concentrations” It’s important to not confuse incompatibility with an expected color change or an insignificant formation of bubbles. A nurse can refer to a drug reference or contact their hospital or facility’s department of pharmacy for assistance.
Related: How the Best Hospital Nurses Use a Do Not Crush List
What Diluent or Fluid Are You Supposed to Reconstitute or Flush With?
You don’t just want to make sure the drugs are compatible. Check what fluid they’re in such as normal saline or dextrose. And what percentage of NaCl or dextrose it is makes a difference too. The label on the drug from the pharmacy usually has this information. Or you can read it from the chart or directly from the IV bag itself. Remember that D5W is an abbreviation for 5% dextrose in water which is the same as dextrose 5% which you may hear spoken as simply, “D5”.
Just because the two drugs are compatible doesn’t mean their diluents are. For example, ceftriaxone is generally compatible in both NS and D5W but what about LR or a TPN? So when you check compatibility, check the drugs and the diluents and any flush you plan on using. Your typical saline flush is 0.9% sodium chloride. But drugs such as certain formulations of amphotericin cannot be flushed with those standard saline flushes. It’s not compatible. Certain formulations of amphotericin need to be flushed with dextrose 5% instead.
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How Long Do You Need to Run Each Infusion For?
Some nurses get so distracted by the question of IV compatibility that they don’t think about the length of the infusions. If a drug only needs 15-30 minutes to complete, it may already answer the question of how you’re going to give all these meds with just a single line. You might be able to plan out which medication you will give in which order, or which might be able to be temporarily paused for a quick IV push or short infusion, once you check how long each bag is supposed to run for. This information should be found in the chart or you can reach out to a pharmacist.
Are You Checking for an Admixture or a Piggyback?
Ensure you understand the compatibility question. Do you want to mix two or more drugs together in the same bag or syringe? Or they’re in separate bags but you just want to run them together via y-site? Some medications are compatible at the y-site but they’re not compatible if combined together in the same bag. Usually, nursing wouldn’t be adding more than one ingredient to a fluid for administration to a patient anyways however you will see these terms in a compatibility reference such as Trissel’s.
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Related & References: https://www.wolterskluwer.com/en/solutions/lexicomp/resources/facts-comparisons-user-academy/trissels-iv-compatibility-databases
