Our organization recently changed the administration time of Zosyn (piperacillin/tazobactam). Patients with normal kidney function will receive Zosyn 50ml over 4 hours (every 8 hours). Due to the slow administration rate 12.5mL/hr. it is infused via pump with a carrier solution. Problems have been identified with this.
1. Our infusion pumps are not smart pumps where the administration rate can be programmed to speed up and slow down. Its one rate primary rate and piggyback rate.
2. Our pump tubing is 27ml. The piggyback tubing is 8ml.
So, we had been setting the pump for 4 hours but the 1st 2 hours is just the carrier fluid. Then the patient received the med at 12.5ml/hr and then the carrier fluid would take another 2 hours to push the med through. The pharmacist working on this change states the med has to be delivered over 4 hours.
We cannot figure out how to meet this standard without changing our nursing practice of infusing antibiotics without a carrier fluid, back flushing, etc.
Other hospitals have switched to 4 hour infusions but they either have smart pumps or have not identified this problem.
The only other option we can come up with is to have the Zosyn infuse continuously. This would tie up infusion pumps for only one med. We do not have enough for every patient as it is.
Any thoughts??? Am I missing something??
Do you prefer to have this infuse for only 4 hours, then after flushing from the line, disconnect from the patient until the next dose? Or do you prefer to have this as a continuous infusion with the carrier fluid infusing between doses. Given your pump situation with the goal to infuse and then disconnect, the nurse would have to manually flush the tubing of all carrier fluid until the drug reaches the end of the IV set - priming the set into the trash or sink. You would need to add the set volume to the 50 mLs of the med volume, then divide by 4 and use that as your rate instead of the 12.5 mL per hour currently being used. This would allow all of the med in the tubing to reach the patient.50 + 27 = 77 / 4 = 19.25 mL per hour. You may still loose a very small amount in the piggyback tubing but this should only be 2-4 mL or so. I am assuming that this entire piggyback set would not empty and leave a set filled with air. Then the carrier fluid would infuse until the nurse returns to disconnect from the catheter. I would still do a manual saline flush before and after this process to properly assess the patency of the site, checking for blood return, and using the correct flush-clamp-disconnect sequence based on the type of needleless connector being used. 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
Thanks Lynn. We prefer to infuse for only 4 hours because other antibiotics have to be snuck in between. Your suggestion of manually wasting the 27ml in the tubing first is most likely the only option other than having a 24 hour dose hanging continuously. Unfortunately, this would tie up a pump continuously.
Do you move these pumps from patient to patient between doses? If so, this seems like such a waste of time for all that cleaning or are they not being cleaned between each patient if they are being moved. maybe I am missing your point, but if a patient is having anything infused through the pump, it should remain in that patient's room regardless of whether it is intermittent or continuous. 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