Q We are having an ongoing debate with anesthesia about compatibility of drips going into “manifolds” (devices with multiple ports/stopcocks). The manifold is then attached directly to the catheter lumen, often with a flush behind it. Compatibility charts frequently say the drips are not compatible, yet the patients come to us with drips running.

A Earnest Alexander, PharmD, replies:

Intensive care unit (ICU) nurses who care for high-acuity patients receiving numerous intravenous (IV) medications may feel that the choices and options for safe and effective drug delivery are diminished when the pharmacist or a drug administration handbook state that 2 or more of the agents are incompatible. In many instances, the incompatible drugs are already infusing together before the investigation ensues and the problem has been identified. In all cases, upfront dialogue among nurses, physicians, and pharmacists regarding which combinations of these IV medications may be administered concurrently is needed...

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