I work at a rural Home Health Agency that does the care and instruction for home IV patients. We do not provide the IV medications. For the second time in 2 months we have had a Pharmacy med provider request that we administer Rocephin as an IV push med. Since this was for us a new request for way of administering Rocephin we looked in our reference (2007 Gahart IV Med book; 2007 PDR and Nursing 2008 Drug Handbook) and found that it stated "a single dose must be further diluted with 50 to 100 ml" As such we requested that it be further diluted and given via intermittent infusion not push. Each Pharmacy did agree with our request, however, we were told that "all the other agencies give it IV push" and that they "have been doing this for years". In both cases I asked for the references they used to determine that IV push was appropriate but did not receive them yet. I don't want to insist on something that is not necessary but I don't want to ask my staff to do something that is not appropriate or accepted practice. Thanks for your help.
Barb Sargent
Wellsboro, PA
Hallene E Utter, RN, BSN Intravenous Care, INC
Lynn Hadaway, M.Ed., RN, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Ann Zonderman, BSN, JD, CRNI, LHRM
FYI - It may not just come down to the osmolarity and pH - I worked on a legal case where the patient had 10 years of frequent IV mini bag Rocephin infusions and began to develop an allergy to the drug... the next dose given 2Gm in 10 cc syringe - IV PUSH over 2 minutes - profound reaction happened minutes later , patient died .. moral:
IF you are infusing with mini bag/tubing the rate of infusion will be slower - more control of the amount of drug administered... and you are able to observe signs / symptoms of adverse reaction as you infuse, and possibly intervene to prevent a tragic outcome.
Ann Zonderman, BSN, JD, CRNI
We have been giving Rocephin IV push for many years in the homes without incident. Susan Poole, RN wrote an excellent article about IV push medications several years ago (1999 in JIN, Infusion, and ASHP). Our guidelines for Rocephin are as follows: 1gram in 10ml sterile water (10mg/ml) slow IV push over 5 minutes via a PICC line. If we have to give 2gm we split the dose and give 1/2hr apart...never 2gm in such a short period of time; lately we have been giving 2gm in homepumps. Susan's article give references. Rocephin mixed 1gm/10ml = 423 mOsm/kg. Our policy also states may give IVPush to ages >11 yrs old.
Marianne Valentine, RN, BSN, CRNI
Nurse Manager
Pharmacare Infusion Services
Cumberland, MD
Well, I cannot be of any help in this discussion because our home health care agency (in Michigan) also just had our first request to administer ceftriaxone/Rocephin IVP. It is ordered 2gm in 50ml 0.9 Nacl (in a syringe), IVP over 3-5 minutes. The pharmacy has supplied the drug already reconstituted and diluted in the syringe. It seems the final dilution should be closer to 70ml instead of 50ml...(?)
Please advise......
Laura Lenihan, RN
Clinical Specialty Coordinator
Henry Ford Home Health Care
(313) 874-6572
fax (313) 874-6501
Rocephin is a cephalosporin. For many, many years, most drugs in this large family have been given by IV push over 3 to 5 minutes. Back in the 1970's, IV push was the one and only method for administering these antibiotics, however this family of drugs alone has greatly expanded now. So this method of delivery is definitely not new. You should read the drug package insert and drug monograph for each drug to check for drug-specific information on dilution and rate of administration. I would strongly recommend the book, Intravenous Medications, published annually by Mosby. In my opinion, this is the one, and so far only, resource that is the most comprehensive information for IV drugs. The nurse responsiblie for the administration (directly or thru patient education) must know what the literature says about the drugs we are giving. Lynn
Lynn Hadaway, M.Ed., RN, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861