an Oxacillin IM question.

[Yonsei94RN]

Hi there

A few days ago, MD ordered oxacillin 2g IM as an stat order at night because patient's PICC line was clogged and totally blocked (an original order was oxacillin 2g IV). Since a night nurse was there, she took care of all new stat orders. Yet, as a new graduate nurse, I sometimes think what I would do if I was at that situation.

My question is this: Oxacillin should be diluted 250mg/1.5ml before IM injected. If 2gm of oxacillin is ordered, it's gonna be total 12ml. right? However, gluteal muscle of human body can not be tolerated more than 4-5ml amount of any meds, according to fundermental nursing that we learned from a school. Sounds may stupid, but is it ok to give each of 4ml oxacillin injections at dorsogluteal, ventrogluteal, and vastus lateralis respectively? at slow rate?

I know it sounds silly, but I really would like to listen your advice.

[canoehead, BSN, RN]

I'd call the pharmacy and see if they would approve a more concentrated solution, or more in each site. Sometimes different references will give more or different information. But, yeah, I think you are looking at 3 or more IM injections. If the pt is really muscular perhaps less...call pharmacy.

[nowplayingEDRN]

That would have been 1 order, based on dilution recommendations, that I would have questioned...and I would not have hesitated to call the MD back, after having verified my info and asked is there is an acceptable substitute...either that of I knwo a Surgeon that would be unclogging a PICC line in the middle of the night so that the medication could be administered properly. My question though is, how on earth did the PICC line become clotted to begin with.