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Iv Zosyn

Question:
Literature review from INS and other sources list Zosyn (pippercillin/tazobactam) as a vesicant, yet I can't figure out why.
According to my information, both the 2.25-4.5 and 3.375 gm solutions have a pH (in D5W and NS) between 5.1 and 6.7 and with osmolarity of 270-330 for the ones diluted in D5W and 445 for that in NS. How then, with "acceptable" ranges, is this considered a vesicant?
Lyn, can you shed some light on this?
Thanks in advance!

lynncrni
What INS resource?

You will have to be more specific about the INS resource you are referring to. INS has never published a list of drugs that are vesicants. Also what other resources? Osmolarity and pH are 2 important factors in the issue of vesicants and irritants, but not the only factors. Drugs have other components that can lead to phlebitis and tissue irritation even when the pH and osmolarity are within the normal range. I am now looking at the monograph for Zosyn in Intravenous Medications, the Mosby book. There are some issues with chemical compatibility and there is a warning about phlebitis, but not mention of tissue damage with extravasation. So I am not quite sure what literature you are actually reading.

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

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

INS publication

http://www.nxtbook.com/nxtbooks/ins/newsline_20090304/index.php?startid=6

Thank you for your reply.
And yes, though I realize that other factors exist beside pH and Osmolarity, I found the information from INS Newsline March/April 2009 which was written by the INS education manager, Ms. Marinucci.
I hope the attached pasted link works.

Patricia Jean
Zosyn

I too received Zosyn on a list from the vendor who trained me as a med that required central infusion. I incorporated this in to my practice. I then moved to another institution who did not have this as their practice. I inquired to the clinical pharmacist and was told that Zosyn had undergone a "re-formulation" and the pH was no longer an issue. I researched the pH and found the same as you, between 5.1 and 6.7. Can anyone provide more insight?

daylily
An old question, but one that

An old question, but one that was never answered regarding is it a vesicant or not.  Our hospital is making the move to a 4 hour infusion every 8 hours or 4 hour infusion every 12 hours, based on patients renal function.

This is a new concept and I fear the need for multiple short peripheral IV sites due to blood transfusions, incompatibilities, etc.

Are patients receiving PICCs more often to provide stabile access, multiple lumens to accommodate these frequent long infusions?

lynncrni
 Intravenous Medications says

 Intravenous Medications says that it causes thrombophlebitis but no mention of it as a vesicant or causing tissue necrosis. There is no pH listed and no osmolarity either. This is a combination drug so this information may be in the package insert. Lynn

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

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

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