[babynurse72]

Here's my question.. I work in a Level 2 in which we reconstitute our own Amp and dilute our own Gent. When you reconstitute the Gent (to 2mg/ml), and you prepare the syringe and mini-infuser tubing, do you leave any add'l vol over the amt you plan to infuse, or do you fill the syringe with exactly the vol to be infused? Some of our nurses do it differently and I was curious about the "rest of the world".
THX

[frannybee]

In our hospital the policy is to fill the syringe with exactly the amt you need.

[NICU_Nurse]

In our nursery, we use syringe pumps to infuse Gent (we usually give maintenance doses of Amp IVSP). We connect the syringe to a filter primed with NaCl or SW. We only draw up what is needed for the dose (our syringes are low-waste syringes; the hub is accounted for when they label the increments, and the amount in the hub is negligible). We connect the syringe and filter to the port, and set the syringe pump to, say, 1ml over however many minutes. When it is finished infusing, there will be a tiny amount leftover in the filter and we flush this very slowly to make sure that the entire does reaches the baby. For instance, if we want to saline lock the port after the infusion, we might take a TB syringe with saline and flush the first half, which pushes the rest of the dose in, and then continue flusing the second 0.5ml to serve as a saline lock before clamping and disconnecting the filter. ;>) Do the nurses you know who add extra have a rationale for that? Just curious.

[dawngloves]

Always drew up the exact amount because heaven forbid if the pump went crazy!!!

[KRVRN]

We fill with the exact amount, and infuse it through med tubing. Then when it is done, we connect NS and flush the med tubing for 5 minutes. Sometimes, if the volume to be infused in less than 0.4cc (the volume in our med tubing) we will push the med into the med tubing and then run the NS flush for the infusion time.

One time we found out that some fo our syringe pumps had a mL/min. feature on them. This feature was supposed to be removed so no one could accidently choose that feature instead of the mL/hr feature. Well we learned the hard way when a dopamine drip was running mL/min instead of mL/hr. It was noticed when a huge amount of the syringe was emptied when that one syringe should've lasted days. All the syringe pumps had to be collected and checked for the mL/min feature.

[NICU_Nurse]

Good tip- I'll have to mention that at work. Thanks!

[Mofe'ny]

Ditto what KRVRN said for administering gent, etc..
Here's a question for those of you that mix your own meds..... Do you have to verify them with another RN? We changed our policy about 18 months ago and now ALL MEDS given must be verified & double signed by RN's. At the beginning of February we had had no *known* 'dosage' errors that reached the patient (according to our nurse manager) in 12 months. We are all much more aware. So, what is your policy on mixing meds? Our Pharmacy mixes our gent, vanc, and claforan after the first dose--- but they don't mix our dopamine or dobutamine because we have had several syringes come up incorrectly diluted---so I have some reservations about them mixing the abx for us.

[nell]

We mix our own first doses of gent and have the exact amount in the syringe with extra in the microbore tubing. Then we don't need to flush the tubing. Pharmacy sends the "exact" dose (uh well, except for that BIG air bubble...) for subsequent doses and we either flush the tubing slowly by hand or put another 0.6 - 1.0 cc of flush on the pump to finish the dose. We mix our gent 1mg/cc, by the way.

Checking all meds by 2 RNs has been standard practice everywhere I've been for at least the last 5 years - we don't double-sign where I am now, but when charting the med in the computer, we enter the initials of the "checked with" nurse.

We had a Neonatologist recently that wrote all kinds of weird orders so now all med and IV orders have to be checked and signed by 2 RNs at the time of noting, and at the time of administration, safe-dose ranges have to be checked again for each dose.

We also have sooooo many problems with pharmacy. We finally got a pharmacist that understands something about the differences between neonates and the rest of the hospital population, but she is only on during the day (would you believe NO pharmacy at all after 11pm???). Most of our pharmacists are TOTALLY CLUELESS. We have had things like a pharmacist demanding to know why we needed to keep minimum 4 vials of Survanta on hand (we keep down to 24wks). He wanted to draw up each dose when ordered - in the exact amount. Number 1, as I said, pharmacy is CLOSED 11p-6 or 7am. Number 2, until we got the inline adapters, Survanta administration was a sterile proceedure. Number 3, WHEN WE NEED IT, WE NEED IT NOW. NOT IN 1-2 HOURS!

Yeesh! Can you tell I had problems with pharmacy last night???