Before To keep this page small and fast, questions & discussion about this post can be found on another page here. 321 0 obj <>/Filter/FlateDecode/ID[<375F2B8E29F4DA448F0196983DC39AD5>]/Index[273 101]/Info 272 0 R/Length 178/Prev 592955/Root 274 0 R/Size 374/Type/XRef/W[1 3 1]>>stream No visible haze or particulate formation, color change, or gas evolution. Fernndez-Llamazares, M.M. Avoiding common flaws in stability and compatibility studies of injectable drugs. 1287-1292. Physical Compatibility: Physically compatible. None of the included studies followed all the methodological requirements. 2940 0 obj <> endobj The frequency of monitoring electrolytes depends on clinical acuity and renal function (similar to the monitoring of oral repletion above). thiazides, loop diuretics, acetazolamide, mannitol). HWr8}W|MT9'emv2}r-EZvnP%"@NdtpY{wpvtz\4/?>*FGM1@FISbr7rB]sYLwu4&ijm /&)]yZY 40HsWc32ffg0aF+my=.V"[&&p~vk'T cX0;?~3!Lc56@q]uS~ >9"TyrUm@<08XD)j]oX(X4] vo7#%1TFFBiJ$z(Eo` l@Ih Since 1997, allnurses is trusted by nurses around the globe. Compatibility screening of Precedex during simulated Y-site administration with other drugs. Fosinopril Serious Alternative (1) eprosartan and potassium phosphates, IV, both raise serum potassium. Click Get Compatibility once both drugs are selected PEPIDs IV Compatibility tool is included in any every clinical decision support suite 1159-1160. This means prior confirmation is needed that no significant change has occurred in the concentration of either one of the drugs present in the mix.6. Specializes in Critical Care. Federal government websites often end in .gov or .mil. Am J Health Syst Pharm, 65 (2008), pp. Low magnesium levels usually don't cause symptoms. This conversion is an acid-base neutralization reaction. Errors in the administration of drugs in ICUs are due to several factors: the use of high-risk drugs (vasoactive drugs, inotropes, sedatives, etc.) So, potassium uptake is A chance of incompatibility exists whenever any medication is combined or added to an IV fluid. Potassium chloride is inexpensively available and is rarely used in the laboratory. often administered in low doses due to their high drug strength, requiring dilution and a prior assessment to their administration. Has 6+ years experience. WebIV Drug Compatibility Chart A Alteplase (Activase, rTPA) Amiodarone (Cordarone) Argatroban Atropine Calcium chloride Diltiazem (Cardizem) Dobutamine (Dobutrex) Dopamine Epinephrine (Adrenalin) Esmolol (Brevibloc) Furosemide (Lasix) Heparin Insulin (regular) Lidocaine (Xylocaine) Lorazepam (Ativan) Magnesium Sulfate K. Nemec, E. Germ, M. Schulz-Siegmund, A. Ortner. By using a Beckman clinical chemistry Analyzer, 9% sodium chloride injection and 5% dextrose injection solutions at 22. M(P|;7d>XQ&@K;ra`HNi11,o_N*k2'R>!^7& fMnfclfMq1X< 'jjJU**;&2QTmN.bJVB}} q|=yxxEdjgauNX 6cVV I"r|NiaUvzY]Oy K#0@'YVio|{G@ ;|'mYV? =F*:-D1:wSrQ,]s uC#g= Q[ Recently I had a patient that needed both iv k and iv mag. The https:// ensures that you are connecting to the A fractional excretion of potassium >9.3% suggests renal potassium wasting (with sensitivity of 81% and specificity of 86%). WebMany people may need magnesium supplements. Time is required for potassium to enter the cells. hbbd```b``" mT|"e?HiA09DJYY R fIF^-0[D_ e:L ; ^ Storage: Room temperature of 22 C. 1) Se realiz una bsqueda sistemtica en las bases de datos Medline, Stabilis, Handbook on Injectable Drugs y Micromedex, para completar y actualizar la informacin disponible. The antidepressant is a form of azoteantidepressants. Chemical Stability: Chemically stable. Epub 2011 Aug 4. None of the papers studied met all of the quality criteria established in this review. Studies conducted to assess the stability of the mix: (a) transparency: for visible particles, observation with a matt black panel, automatic particle count or turbidimetry; for subvisible particles, use of optic microscopy, spectrophotometry or turbidimetry; (b) change in color: visual inspection or spectrophotometry; (c) gas formation: visual inspection; (d) pH; and (e) chemical stability: measurement of the variation of the concentration of the 2 drugs. Number of tests run (at least in triplicate). Also, in this case, I'd want to correct the hypomagnesemia prior to administering the K+, since as I mentioned above, the low K+ may be refractory to treatment in the presence of hypomagnesemia. @'c[: pg6~ 0No2J:xWk^`+0Hg| 0BPo>E`3J_9`cX2!E[X\ZK-zgAQTT"AMKhj\.'1aq1|@1B9[kz]K/3c2jp{?OVL1 If you have persistently low blood magnesium levels, this could lead to low potassium and calcium levels. Chemical stability studies, however, are not because they require more sophisticated analytical techniques to determine the initial and final concentration of drugs. Errores de medicacin en los servicios de medicina intensiva espaoles. Available from: C. Lpez-Cabezas, D. Soy, L. Guerrero, G. Molas, H. Anglada, J. Ribas. Potassium administration by intravenous route should only be used if the oral or enteral route is not available or does not have the required serum potassium increase in a clinically acceptable time. Of these, 366 are compatible (77.1%), 80 are incompatible (16.8%), and 29 are compatible in specific conditions (6.1%) as shown in Table 2. Serum hyperkalemia is dangerous. N. Beauregard, N. Bertrand, A. Dufour, O. Blaizel, G. Leclair. Sheesh! Am J Heal Syst Pharm, 58 (2001), pp. Physical Compatibility: Physically compatible. In the absence of renal dysfunction, it's often useful to target a high-normal potassium level. If you have persistently low blood magnesium levels, this could lead to low potassium and calcium levels. Online Medical Education on Emergency Department (ED) Critical Care, Trauma, and Resuscitation. Your email address will not be published. Incompatible: amphoteracin, cephalosporins, erythromycin, penicillins, phenytoin, potassium chloride, heparin, thiopentone, tetracyclines, vitamins B and C, nitrofuranoin, warfarin pH: 4.5 %%EOF Our hospital stopped using IV potassium because we had too many sentinel events involving their use. Compatibilidad fsica del bicarbonato sdico con frmacos de uso frecuente en la unidad de cuidados intensivos. Incompatibility between calcium and sulfate ions in solutions for injection. The problem is that magnesium blocks potassium secretion back OUT of the cell, and with low intracellular mag levels, potassium is allowed to freely exit the cell. If you are author or own the copyright of this book, please report to us by using this DMCA report form. Online databases like Stabilis 4.0 are very useful to look for information on drug compatibility. The research was published in the journal Neurotypical and was released online on December 4, 2013. Clinical review: medication errors in critical care. Our review is based on the previous work done by Kanji et al.5 in Canada and Lpez-Cabezas.7 in Spain. Combinations of physical and chemically compatible drugs with concentrations below the reference mark. However, information on drug compatibility is scarce and, on many occasions, difficult to interpret due to the different concentrations used, the lack of information on the assessment techniques used or the suspicious technical quality of the sources. Articles published from 1990 to 2017 in English, Spanish and French were included. Stability of cyclosporine with magnesium sulfate in 5% dextrose injection. Disclaimer. The rest is in bones and cells. Administer IV dose over 2 to 3 hours for mild or moderate hypophosphatemia and over 6 to 8 hours for severe hypophosphatemia 18. It is important to recognize that compatibility is not just Summary of the quality criteria of the papers published. Webcompatibility prior to coadministration. 2,816 Posts. Boxes were named with a C if the mix was compatible, with an I if incompatible and with I/C if stability depended on special conditions. Reference: Pharm Technol Hosp Pharm, 2 (2017), pp. Storage: Room temperature of 22 C. Sociedad Espaola de Medicina Intensiva, Crtica y Unidades Coronarias, rea del Medicamento. A chance of incompatibility exists whenever any medication is combined or added to an IV fluid. WebCompatible: metronidazole, ranitidine, vancomycin Intermittent Infusion 30-60 minutes Dilute with 50-100ml NS, G. Preferred concentration 2.5mg/ml in NS. Failure to treat the magnesium deficiency will make it difficult or impossible to fix the hypokalemia (hypomagnesemia causes renal potassium-wasting, so the patient will keep on spilling potassium until their magnesium level is repleted). Of these, 366 are compatible (77.1%), 80 are incompatible (16.8%), and 29 are compatible in specific conditions (6.1%) as shown in Table 2. Compatibility depends upon many factors including temperature, pH, IV fluid, concentration, order of mixing and brand of drug. Incompatible: amphoteracin, cephalosporins, erythromycin, penicillins, phenytoin, potassium chloride, heparin, thiopentone, tetracyclines, vitamins B and C, nitrofuranoin, warfarin pH: 4.5 Medicina Intensiva mainly publishes Original Articles, Reviews, Clinical Notes, Images in Intensive Medicine, and Information relevant to the specialty. It takes 3-4 hours for the Mg2+ in kidney and heart cells to exchange with the Mg2+ in plasma, meaning that you should give the mag first so it has time to start moving into the cells so that it is more likely to be effective in blocking potassium excretion. Table 1. (ii) Article quality was analyzed according to the stability studies practice guidelines. Figure 2. Infusions remained stable at 22 degrees C. For 24 hours. Figure 2. The terms used were physical compatibility, drug stability, y-site, y-injection, intravenous drug, plus the names and synonyms of the drugs of interest. Isn't this an ED Nursing thread? Report DMCA Overview It has been completed with the new information available on drugs in our setting and data on the most widely used concentrations of drugs. IV magnesium may be the fastest way to reduce the risk of arrhythmia (because magnesium can be given rapidly). ;}9fUe ][n, 77"^tSg7~Yk^m_m_m_mMT Zbqx| j Specializes in NICU, PICU, Transport, L&D, Hospice. In my time there we have still never used IV potassium and opt for PO k-dur instead. Copyright 2009-. Potassium is flowing into the cells just fine. S. Kanji, J. Lam, C. Johanson, A. Singh, R. Goddard, J. Fairbairn. Report DMCA Overview J.T. Just out of curiosity, what order did the MD write for them in? Cells with low potassium are leaking the potassium they are receiving right back out, which decreases the net uptake and secretion. Aggressive repletion of mild hypokalemia in patients with renal failure (. N. Baririan, H. Chanteux, E. Viaene, H. Servais, P.M. Tulkens. A clear and con-cise compatibility chart can be a useful tool in helping to deliver safe, high-quality IV therapy to patients. Vasoactive drugs, analgesics, and sedatives are among the most widely used therapeutic groups and are usually administered in continuous infusion. All works go through a rigorous selection process. Another factor is the prescription of doses in different units of measurement or the high number of drugs used with each patient. UAiM 0g `%u?J[ +sC e#)7p:iQZ>`} d/ J;#A- 0 IJp C%tu0t}vN0{3):UVww A;{ ?M=]\:Zk-=%]%Q`l WebIv Medication Solution Compatibility Chart For Nurses Uploaded by: run.rebel.run April 2020 PDF Bookmark Download This document was uploaded by user and they confirmed that they have the permission to share it. there is an average 1.7 errors/day associated with the process of drug administration in the ICU setting.1 On the other hand, the data reported by Merino et al. We don't infuse potassium into the cells, we infuse it into the serum and then depend on good net uptake to improve potassium levels, it's sort of like cells are scooping up potassium with a bowl, except those with low magnesium are scooping them up with a colander. Mixing solutions containing calcium or magnesium ions has a substantial risk of forming an insoluble calcium or magnesium salt. For deficiency that is not severe in older children, some manufacturers have recommended 1 g (2 mL of 50% solution) once or twice daily by IM injection. Web17. Storage: Room temperature of 22 C. If the urine creatinine level isn't known, then the urine potassium concentration can be used as a rough surrogate (with a cutoff of >>15-19 mM indicating renal potassium wasting). (2) Severe hypokalemia in need of emergent treatment (see risk stratification above). Infusion of potassium at a rate of 40-60 mEq/hr is reasonable if the patient is extremely unstable (with the judgement that the inability to provide insulin is a life-threatening problem). Report DMCA Overview Antimicrob Agents Chemother, 45 (2001), pp. Want to Download the Episode?Right Click Here and Choose Save-As. For deficiency that is not severe in older children, some manufacturers have recommended 1 g (2 mL of 50% solution) once or twice daily by IM injection. D. Brossard, V. Chedru-Legros, S. Crauste-Manciet, S. Fleury-Souverain, F. Lagarce, P. Odou. The magnesium administration, which is concomitant with potassium, aids in tissue replenishment of potassium. WebThe primary endpoint of the study (change in serum magnesium level after 6 to 24 hours) was greater with IV therapy than any dose of oral therapy (mean change 0.24 mg/dL vs. 0.05-0.11 mg/dL, p=0.003). The .gov means its official. Stability and compatibility of ceftazidime administered by continuous infusion to intensive care patients. Search for and click on a drug 2. Rapid administration may cause serum levels to be elevated (even though there is a total-body potassium deficit!). The problem is that magnesium blocks potassium secretion back OUT of the cell, and with low intracellular mag levels, potassium is allowed to freely exit the cell. Carasso, R.A. Kennedy. Clipboard, Search History, and several other advanced features are temporarily unavailable. But, I'd be curious to hear the OP's rationale as well. What Are The Best Exercises For A Flat Tummy? and transmitted securely. Mmmm, sort ofintracellular Mg2+ modulates the transport of K+ *OUT* of cells by blocking secretion of K+, so if there is a deficiency of intracellular Mg2+, then more K+ is secreted by the distal renal tubule. Of these, 366 are compatible (77.1%), 80 are incompatible (16.8%), and 29 are compatible in specific conditions (6.1%) as shown in Table 2. Well, while I'm not sure I agree with the other RN's verbiage, she is correct that hypomagnesemia can make hypokalemia refractory to treatment, so hanging the mag first would be the correct action, as far as I know. San Francisco General or Highland Hospital. Index Medicus / MEDLINE / EMBASE / Excerpta Medica / SCOPUS / MEDES / Science Citation Index Expanded, Journal of Citation Reports, The Impact Factor measures the average number of citations received in a particular year by papers published in the journal during the two preceding years. allnurses is a Nursing Career & Support site for Nurses and Students. S. Manrique-Rodrguez, A.C. Snchez-Galindo, C.M. Traditionally, the target has been >4 mM in efforts to reduce the risk of arrhythmia. Less than 5% change in measured potassium and magnesium concentrations occurred in 24 hours. Stability of ranitidine hydrochloride at dilute concentration in intravenous infusion fluids at room temperature. Only 6 studies assessed the chemical stability of the mixes being high-resolution liquid chromatography the method used in 5 studies to measure the concentration of the active ingredients of the mix. Critically ill patients often have limited venous accesses. Ideally, you give mag first, although it's not critical to do so. Use serum magnesium values to guide continued dosage. Webmagnesium and potassium solutions in the Intravenous reduces energy levels and raises the possibility of electrocardiographic fibrillation. This review focused on analyzing the physical and chemical compatibility of the IV drugs most commonly used through Y-site infusion in the ICU setting and summarizing the information obtained in a double-entry chart. Webimportant to recognize that compatibility reflects only the physical interactions such as formation of a precipitate and does not necessarily address stability or pharmacologic activity of the products. Beta-agonists (albuterol, terbutaline, epinephrine including endogenous epinephrine surges from stress). Web17. Carmen Lpez Cabezas: study design and idea, data mining, analysis and interpretation of data; paper draft or critical review of the intellectual material; and final approval of this version. Danner. The compatibility of these is shown in Fig. Stewart, F.W. It is consistent with the gray boxes specified as I/C as shown in Fig. IV or IM. Ideally, this shouldn't be run through a single peripheral IV line (to prevent vein sclerosis). However, 93% guaranteed correct reproducibility. Am J Health Syst Pharm, 54 (1997), pp. Thank you you for your response to that ? Repeat electrolytes if doubt exists about their validity (e.g., inconsistent with clinical context & EKG). J.A. Compatibility of propofol injectable emulsion with selected drugs during simulated Y-site administration. 651-658. The systematic review included 29 studies (27 originals, 2 reviews). Study drugs and concentrations used as reference for the bibliographic search. The transtubular potassium gradient (TTKG) is no longer recommended. However, chronically low levels can increase the risk of high blood pressure, heart disease, type 2 diabetes and osteoporosis. (2) Markedly elevated cell counts (leukocytes take up potassium while the blood is awaiting analysis). (1) IV potassium should never be given as a bolus. Akkerman, H. Zhang, R.E. It is important to recognize that compatibility is not just Out of the 29 papers included in the review, 4 were written in Spanish, 3 in French, and 22 in English. Low magnesium levels usually don't cause symptoms. Reference: SRJ is a prestige metric based on the idea that not all citations are the same.