When we are giving a single intermittent IV antibiotic via electronic infusion device with no primary infusion should we have a bag of maintenance fluid or is it ok to flush through the port to get the antibiotic out of the tubing?  Or, what is recommended?

My big question is why does

My big question is why does an antibiotic require rate control on an infusion pump where the tubing will retain such a large volume? I simply do not see the need for such high end rate control for antibiotics such as a cephalosporin, etc. These can be piggybacked into primary fluids, even those fluids on a pump, but the secondary med tubing would not retain such a large volume of the dose. What infusion pump are you using for these antibiotics and what is the rationale? It seems like a huge waste of money to me. Lynn

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

It is dependant on the

It is dependant on the situation/medication.  If it is a 50 cc minibag that is to be given q 24hour, for instance, then get an order for a 50 cc saline flush bag before and after the IV medication, that is if the pharmacy can't dilute it in 100cc.  Percentage lost with a 19.2 priming volume for 100cc is 19.2% (or 192 mg of a 1 gm rochephin, for example).  Our pharmacy does not advocate for a secondary when 100 cc volume is used.

Were you on Monday's conferance call?  We reviewed the question of diluents to be delineated in every order.. i.e. Rocephin 1 gm IV q 24 hours should be Rochephin 1 gm in 100 cc NSS every 24 hours. In my opinion, we should start preparing our facilities to get this information as apparently surveyors are looking for this to be included in an IV order. (INS makes reference to this)

Therefore, any saline or D5W flush bags to "chase" the antibiotic in and flush a large portion of the medication out of the tubing, needs to be in the orders.

The hospital where we take our IV students for precepting has tubing which has a priming volume of >27 mls.  Therefore, antibiotics are always used as a secondary infusion. 

Does that help?

Diane

So, do you have standing

So, do you have standing orders for the secondary fluid bag?  Or, do you get orders dependent on each med and the frequency given?  Should this be addressed in policy?

Robin, That is appro. 38%

Robin,

That is appro. 38% which is left in the tubing. If this was once a day dosing (ie. Rochephin) I would definetly have a main line of NSS and give the IVAB as a secondary.  Are you using the Flogard 6201?

If the dosing was q 4 or q 6, then the next dose would "chase" the previous one and the % lost would be less. Perhaps the pharmacy could send out 100ml diluents, unless contraindicated for the pt (i.e. FR)

Diane Davis RN, CRNI, BA

Omnicare Special Services - Interlock Pharmacy

  

Thank you for the

Thank you for the reply.  This is for intermittent antibiotic infusion using pole-mounted pump in the long term care setting.  Many of these could be infused via gravity, but often just one nurse to 20 or more residents and they like having the pump. The tubing being used has a priming volume of approx 19.2ml.  So, for instance, an antibiotic in a small volume of fluid (50ml) could be a significant amount of drug left in the tubing. 

We use the CADD Prism pump in

We use the CADD Prism pump in the home for this and it is programmed to deliver enough drug between the intermittent doses to keep the line open so there is no need to flush the antibiotic out of the line between.  Is that what you are asking?

Valorie Dunn, RN, BSN, CRNI

Home Health Pharmacy Infusion Therapy Coordinator

Franciscan St. Elizabeth Health Lafayette, IN

I have always practiced by

I have always practiced by giving intermittent infusions without any concern for the residual amount left in the tubing. Does this have to be controlled on an infusion pump? Why? Are you talking about an ambulatory infusion pump or a pole-mounted large volume pump? Is it some critical drug that requires such accurate infusion rate? I would agree that the pole-mounted volumetric pump tubing will hold more than the regular gravity tubing, but check the actual volume. It is probably still small and well within the amount of overfill that is in the fluid container. Ambulatory infusion pumps usually use microbore tubing, an even smaller amount. A flush bag of fluids could be too much fluids for your patient, depends on their condition. Also this adds expense that I would consider to be unnecessary. Is this home care? Would this create such a complex infusion that it would be difficult for the patient? I really do not think that the discarded volume will be a sufficient amount to worry about. Lynn

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861