IV antibiotic infusions

pattchez · Jan 29, 2006

In the dialysis center where I work we did use a pump for IV antibiotics given after dialysis -- our policy reflects that. You may want to check around the city or region where you work and see what similar size dialysis units practice is. With the emphasis on patient safety, I believe you could make a case for using an IV pump.

kafo · Jan 29, 2006

Thanks for the reply. I have my yearly eval soon and this will give me somewhere to start.

:rolleyes:

Mastersby2011 · Jan 31, 2006

My clinic gives the antibiotic by pump over the last hour if it is not dialyzed out or immediately after if it is. They wanted us to direct drip it through and the nurses all had a fit. We felt it was unsafe. Good luck with your unit.

Trvln Nurse, RN · Feb 15, 2006

In the clinic were I work at we had only one partially working IV pump for 100 patients. I went to my manager and made the case for new IV pumps. It was met with criticism at first....(as pumps cost money)...the criticism was even directed at me (since I have primarily a hospital critical care background....she indicated that clinics can't afford the equipment that hospitals can)....but I held my ground as this is a big safety issue. I simply stated the numerous safety issues (ie....bags not being 'burped' air not being removed first....the risk of air imbolus....the risks of vancomycin and other antibiotics being infused to quickly. When my manager criticised me....I admittedly got a bit upset as I was only trying to advocate for the wellbeing of the clinic, patient safey (not to mention my nursing liscense)...and I stated to her..."you're the manager....why aren't you conserned about this issue? Why aren't you bringing it up?" Well, after she thought about it...she went into action discussing costs and availability of pumps and proper IV tubing with our technician who purchases items for us....and the next day....We had two new IV pumps for our clinic. I'm glad I work with a manager who will give some thought to issues nurses bring up.

Now I understand that not all clinics have pumps...though I think they should. But if you are in a clinic without a pump or find yourself without one you should ALWAYS burp the IV bag so as to remove the risk of air embolus. Dialysis is a busy arena.....it's not like we can sit around and monitor the drip closely.

The other point. I usually give Vancomycin over the last hour of treatment (using a pump attached to the venous chamber). Most other antibiotics are given post treatment. As there are also "turnover" and "transportation" issues that play into the timing of things as well. I also keep a book as to what medications dialyze out and what don't close at hand.

I'd be curious to hear what other clinics are doing? Do you use an IV pump?

Trvln Nurse, RN · Feb 16, 2006

Question....for those of you who direct drip antiobiotics while the patient is still on dialysis (ie...Vancomycin) Do you attach to the arterial port? Are you concerned as to how much is getting dialyzed out? For antibiotics given after treatment....are you removing the air from the IV bags first? How do you feel about not using an IV pump?

Kenchiro · Feb 26, 2006

Ok we dont use IV pumps in the clinic I work in. Our Physicians have said to run only Levaquin and Vancomyacin while the patient is still on the machine. They have told us not to start them until the last hour of treatment.

We calculate drip rates the old fashioned way. Also we draw Vanco and Gent levels as they apply to the patient in question before each treatment they will be recieving that medication.

Our facility has 36 chairs and we generally fill 32 - 34 of them Mon - Sat.

So our clinic is very very busy.

NephroBSN, BSN, RN · Feb 27, 2006

Question....for those of you who direct drip antiobiotics while the patient is still on dialysis (ie...Vancomycin) Do you attach to the arterial port? Are you concerned as to how much is getting dialyzed out? For antibiotics given after treatment....are you removing the air from the IV bags first? How do you feel about not using an IV pump?

Arterial port, slow drip, remove air from bag when it's spiked.

Vanco 1000 mg over one hour, 500 mg over 45 mins.

Ancef IVP at the end, others last twenty minutes.

Although I've worked where ALL antibiotics were given after treatment.

Gottal like those pumps though.

SugarHanie · Feb 27, 2006

Question....for those of you who direct drip antiobiotics while the patient is still on dialysis (ie...Vancomycin) Do you attach to the arterial port? Are you concerned as to how much is getting dialyzed out? For antibiotics given after treatment....are you removing the air from the IV bags first? How do you feel about not using an IV pump?

For my clinic's practice, we attached it to the venous port and infused it manually. I'm not so sure if you were to attach it to the arterial port and let the anitbiotic pass thru the dialyzer, would it be dialyzed out. I have yet to find out.

After a long debate about the manual infusion, we decided to use IV pump as it's much safer.

Post dialysis antibiotic infusion, we used to maual infuse and keep a close watch on it. We had never practice removing the air from the bags.

Juanay · Mar 5, 2006

Being a traveler "When in Rome"

Protocols are different in every unit. Every state.

Vanc 2 G over 2 hours, burp bag through arterial.

Same situation through venous with pump.

I've seen Gent given with RB and shudder since it is ototoxic. I've seen Ancef and Fortaz given post tx and allowed to run through.

Protocols where I currently practice are all per pump:

Vanc 1 g over last hour 2 G over 2 hours through venous port.

Gent, Ancef, Fortaz post tx over 20 min.

We are also allowed to give blood faster. 1 Unit PRBC's over 20 min through the arterial to allow the dialyzer to filter.

Juanay

NephroBSN, BSN, RN · Mar 6, 2006

Being a traveler "When in Rome"
Protocols are different in every unit. Every state.
Vanc 2 G over 2 hours, burp bag through arterial.
Same situation through venous with pump.
I've seen Gent given with RB and shudder since it is ototoxic. I've seen Ancef and Fortaz given post tx and allowed to run through.
Protocols where I currently practice are all per pump:
Vanc 1 g over last hour 2 G over 2 hours through venous port.
Gent, Ancef, Fortaz post tx over 20 min.
We are also allowed to give blood faster. 1 Unit PRBC's over 20 min through the arterial to allow the dialyzer to filter.
Juanay

And for blood early on so you can dialyze off the K.. Where I am now we don't give blood in the unit because we are too far away from the local hospital. Never worked in a unit that didn't give blood if needed or that was too far from hospital to give it.. LOL .. But ask me if I miss giving blood.. Heck nooooooooooo.....PIA...No pump.

Juanay · Mar 6, 2006

We are 24.7 miles from the nearest hosp and have no courier service for labs or blood. We (the staff) have to physically go pick up the blood and take any labs ie...BC's for fever, culture swabs, 24 hour urines. If we have a code we have to run it with all measures even if the pt is a no code per protocol because pts cannot be pronounced dead in our facilities.

Never a dull moment!

Juanay