My hospitals pharmacy has proposed the idea of mixing several antibiotics in syringes instead of IVPB bags of fluid as a cost saving measure. The proposed volumes are Ancef 1gm in 10ml, Maxipime 1gm in 25ml, and Rocephin 1 gm/25ml.
I don't have an issue with the Ancef, but I am concerned about the volumes of the Maxipime and Rocephin. (particularly if the patient doesn't have a running IV, as well as the 30 min infusion time).
I also have it in the back of my head that Rocephin is an irritant, but according to the pH and osmolality chart in the download section, all 3 drugs can be given through peripheral IV sites without risk of phlebitis. I checked the package inserts for Maxipime and Rocephin and both state that concentrations of 10mg/ml to 40mg/ml (voume of 10ml to 25ml) are recommended. No mention in either of need for further dilution.
Is anyone else seeing this in their facilities?
How do you deal with the patient who doesn't have a running IV, but just an intermittent lock?
Sarah Jones
Oncology CNS/Manager Outpatient Infusion Services
This is an example of the adage "what is old is new again". Yes, I know that many home care companies have been doing this for many years - teaching patients to manually push cephalosporins rather than infuse from a bag. I do know that this is moving back into hospitals. When I went to work on my first IV Team in 1972, that is all we did - manually push these drugs. I do know of one study showing that phlebitis is less with a shorter time of exposure to the drug. So shorter infusion times can mean less phlebitis. I would encourage your pharmacist to pay close attention to the diluent being used so that the osmolarity stays under 600 and as close to 300 as possible. This may mean using sterile water rather than normal saline. 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