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Roceephin and Lactated ringers


Here is a new problem I have encountered but unsure if I am looking at the right culprit:  I had several days in which I was called to come see a PICC line having difficulty aspirating and flushing.  Could go up and flush it a few times and it would be good. One of my assistants swore it was positional(?i.e. flushes easier when arm moved.)  When the doctor heard about the problems, he ordered it discontinued.  I noted that the anitbiotic that had just finished infusing was Rocephin and the main line it was infusing through was Lactated Ringers.  I noted on the Rocephin bag there was a statement regarding not mixing LR with Rocephin.  The FDA retracted the statement in April 2009 that this was only a concern for neonates.  Could the rocephin and LActated ringers have caused precipitate in the PICC?  Anybody else have similar problems?

Rocephin is not recommended

In the 2010 issue of Gahart's Intravenous Medications, there is a discussion of compatibility between ceftriaxone and calcium containing IV solutions and RL does contain calcium and states that a precipiate may form.  You should always check the most recent information on compatibility such as King's or Trissel's books. You could have a drug precipaitate formation or tip migration or dislodgment. PICC tip locations do move with arm movement, so there could be some truth to the nurse's concern over it being "positional". Where was the original tip location? Has it become dislodged even a small amount? Any signs of tip migration? Have you obtained a repeat chest xray to verify tip location? Lynn

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

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

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