In the ER I work at, its common to put 2g magnesium sulfate IVPB onto gravity. As a bolus. I had it in my head that the idea was 1g/hr. Recently, there was a mistake and 20g of mag, instead of 2g, was hung, wide open. Luckily it was caught before even 1/3 of the bag was in.

Is it common to give it off pump, pretty much as a bolus?

There are 2 drugs that I will run in w/out a pump - rocephin (in an adult only) and ivpb phenergan in 25mL NS. Everything else is going on a pump. And in my ER, all critical drips are verified by another nurse, and that would be considered a critical drip.

Yikes on the med mistake, thankfully it was caught before any harm was done.

We give phenergan as a IVP. Dilute 12.5mg in a 10cc NS flush. Is your IVPB 25mg?

We can do 25 in 25mL as smallest IVPB. The docs prefer the 50mL but we don't always have it.

The max amount of magnesium that can be administered IV is 1gm over 7 min unless in a code situation. The rate of I.V. injection should generally not exceed 150 mg/minute (1.5 mL of a 10% concentration or its equivalent), except in severe eclampsia with seizures. In paroxysmal atrial tachycardia, magnesium should be used only if simpler measures have failed and there is no evidence of myocardial damage. The usual dose is 3 to 4 g (30 to 40 mL of a 10% solution) administered I.V. over 30 seconds with extreme caution.

MAGNESIUM SULFATE -* Intravenous (IV) Dilution

20 grams of mag???? How many vials did they use to mix that up?? That's a big mistake.

It depends on your policy. I have given MgSO4 off pump especially when given in a liter as a part of the Banana bag for ETOH intoxication. giving MgSO4 a gram or 2 in the setting of a monitored ED patient is an acceptable practice IF in agreement with hospital policy.

Phenergan is administered off pump diluted in at least 25 cc's of dilutent.

http://www.globalrph.com/promethazine_dilution.htm

In a code, yes. Any other time, if it's straight mag sulfate in a 50-100 ml bag, it's going on a pump. There's not a reason in the world to not grab a pump for it. When it comes down to it, you're infusing a cardiac drug.

The 20g bag was made by pharmacy and sent up. It had to do with how the doc ordered it. They order on the computer and I believe it came up as Magnesium sulfate: 20gm in 500cc, dose [to give] 2000mg. In the ER, the nurse calls down for meds that we don't have loaded or premixed. So they don't see the doctor's order, just what the nurse tells them.

Rocephin is the only thing I give off pump. And used to zosyn... before they changed the run-in time to 4 hours!

Rocephin is the only thing I give off pump. And used to zosyn... before they changed the run-in time to 4 hours!

4hrs?! Wow, why the change? Manufacturer? We still run ours in over 30 min. Longest abx we run in takes 2 hours (vanc, etc). 4 hrs is crazy; as much as we use zosyn, we would def have to change meds.

The PharmD found a research study that clearly demonstrated that asthma patients who are given 2g Mag as an IV bolus were less likely to be intubated and die as a result of their asthma attack. I run it our 50 mL bags of 2g as fast as I can in someone with respiratory distress and I do it gleefully!! Breathe!

Never have, or even heard of that. Doesn't seem safe at all.

I have run 1 or 2 g Mag in a 50mL bag wide open via gravity in respiratory distress patients as VICEDRN described, in all 3 hospitals where I have worked.

The 20g bag was made by pharmacy and sent up. It had to do with how the doc ordered it. They order on the computer and I believe it came up as Magnesium sulfate: 20gm in 500cc, dose [to give] 2000mg. In the ER, the nurse calls down for meds that we don't have loaded or premixed. So they don't see the doctor's order, just what the nurse tells them.

Unreal ... that pharmacists at your hospital are willing to leave themselves open to error like that.

Personally, the pumps we have in our hosp are pretty quick to use so I tend to put most of my IVs and piggy backs on pumps.

If I have mag in a 1L banana bag I will run it to gravity. It is easier to control the rate and give it over a hour. But the mag by itself in a small bag, I always run on a pump. Too easy to bolus a 50ml bag in a couple minutes without a pump.

20g bag yikes!