A PharmD from a pharmacy I deal with asked me about changing IV Tubing on Meropenem. He told me that Meropenem has stability less than an hour after reconstitution and at room temperature. He asked if the tubing should be changed with each infusion. I told him that I would reach out to the experts and see what they say. I told him that personally I would personally look at patient safety and I would change the tubing with each dose. I have never seen any kind of problem using the tubing for 24 hrs but as he said, that drug is unstable after an hour. Any suggestions?? Thank you. Warren Willard
The drug monograph says various numbers of hours for storage but when it is mixed with NS, it is only stable for 1 hour. So pharmacy could change the diluent. Are you infusing this with a pump and it is piggybacked into a primary line with NS as the chaser fluid? If yes, then all the medication is infusing to the patient , so there is no issue. Is this a physical or chemical stability issue? If a small amount of the residual med left in the set is infused to the patient, will this cause harm? Use the backpriming method to flush any residual amount back into the empty container from the previous dose. I really do not think you need to change sets after each dose. There is nothing in the drug literature recommending this and there are administrative ways to deal with it.
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
This is not a piggyback infusion. He did not say what it is reconstituted with only that it is unstable after an hour at room temp. If what you say about changed the solution to reconstitute with is true, then all pharmacies should be doing that for intermittent infusions but I doubt that they do and if the tubing is up for 24 hrs then the patient gets a tubing full of unstable solution. I have never seen an issue with that so I will have to ask the pharmacist if they have had an issue with this. Thank you for your response.
Now this is really curious as my literature shows 4 hour stability room temp, and that what is left in the tubing, (given a q8hr tubing) loses potency, and is NOT harmful to the patient when you hang the subsequent bag. So, as long as the sterile, single use end cap is placed on the adminstration sets end after disconnection, that tubing can be reattached to hang the next dose and of course, pitched after 24 hrs use.
Your pharmacy is probably diluting with something other than NS. The one hour period of stability is only with NS.
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
Well according to this Government report, it's stability is much longer 8-12 hrs in Saline, and the range was dependant upon drug concentrations.
https://pubmed.ncbi.nlm.nih.gov/25220554/
A published study is good to have but what the FDA has approved is the most important information to guide practice. Do a google search using "meropenem prescribing information" to bring up the FDA-approved language.
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
I am in Home Infusion.
We have our patients place a sterile white cap on the end and leave the medication bag attached. Place in ziplock bag and place on the top shelf of the fridge. "Bing" says we have 7 days for extended stability in multiple type of containers. Have patient get new tubing every 24 hours.
C. Craig Farris BS,RN, CRNI