Antibiotic bone head question

  1. Please dont laugh but I sometimes have a problem figuring out what the IV med book is saying.
    For example,say Im giving IV Ancef,and the book says "Each 1 Gm or fraction thereof must be diluted with at least 10ml of sterile water for injection. To reduce the incidence of thrombophlebitis, may be further diluted in 50 to 100 ml of 5% dextrose in water,normal saline for injectionon or other compatible infusion solutions."
    So if I want to give an IV intermittant infusion of Anecef, do I dilute it in 10ml of sterile h2o and then mix that into say 100cc of NS?

    When I asked a nurse on the floor how to give the Anecef she said just draw 5cc from the 100cc bag of NS,dilute the Anecef with that 5cc of NS,then stick the Anecef,diluted with 5cc of NS back into the 100cc NS Bag and run it.
    Is that cool? Thats not what the IV med book says.
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  2. 21 Comments

  3. by   nursec
    I think I would go with the book........
  4. by   whipping girl in 07
    I mix my own Abx all the time and I use either the fluid out of the IV bag that I'm mixing it in, or NS from the bag we draw from to use for flushes and to dilute injections (like MS when titrating) if I'm going to put it in a buretrol. If it's compatible with what you are diluting it in, it does not matter what you use to reconstitute it, as long as it's also compatible. You just need to make sure you completely reconstitute ALL of the med and draw up everything in the bottle, so you don't lose any of the dosage. However, if you are going to be using half the med (say, 500mg instead of 1gm) you need to be careful that you put exactly the amount of diluent into the vial so you know how much to draw up.
  5. by   cmggriff
    konni is dead on on this. I usually use the IV fluid I'm going to mix in. But it doesn't matter. Gary
  6. by   globalRN
    ohbet, I am a stickler for going by the manufacturers med insert as to how they want things reconstituted. The drug companies conduct their little studies to come up with their guidelines.

    If the drug insert says to reconstitute the medication in 10 mls of sterile water and does not give other choices: I do exactly that.

    That way you are covered legally. CYA. Also if you don't use it all and someone else uses it, they 'know' you reconstituted with sterile water. Furthermore, when the drug companies quote you timeframes for the expiration of prepared product: they ASSUME you have followed their instruction which is use sterile water, NOT
    n/s, d5w or whatever else.

    Then if you are giving it, you can go by your IV book as to suitable/compatible solutions, dilutions and rate of infusion
    or better yet ...the manufacturer's drug insert.

    Hope this helps and by the way, definitely not a bonehead question!!!
    Last edit by globalRN on Oct 10, '02
  7. by   aus nurse
    I too reconstitute antibiotics all the time.

    If the med book specifies sterile water I use an ampoule of water. If it says either water or saline i often use the mini bag of solution I am going to add it to.

    Some drugs can crystallise with the wrong solution....and these can be too small to see..so it is important to go with the book on the appropriate dilutent.

    Same goes for the amount you need to dilute it with..some will not dissolve properly in 5 mls rather than 10 mls.
  8. by   canoehead
    You can also look at the drug book reference to find the minimal dilution (ie 20mg/ml) for infusion. I dissolve with any compatible fluid but would tend to use as much or more than they recommend so that it dissolves completely. So long as it dissolves completely for withdrawal in the end it will be dissolved in that fluid anyway- getting it in there just needs to be sterile and safe.
  9. by   sharann
    Dilute first by drawing 10 cc's of sterile water into a 10 cc syringe with a good sized needle lumen. Then inject the water into the ancef vial. Shake, shake shake and shake as instructed. No globs or powder residue on the glass. Then simply draw out the diluted stuff and inject into the port of a 50 or 100cc bag of desired infusant.
    By the way, Ancef is frequently given IVP in the OR. They dilute in 20cc's and push it. It is allowable, but I wouldn't recommend it.
  10. by   Brownms46
    Now what different does it make to dilute the ancef with Sterile water if it's put into NS or D5W??? At many hospitals the IVP come with a vial attach to a minibag of D5W or NS. You crack the tubing between the solution and the med vial, squeeze the NS or D5W into the med vial, reconsitute the med, and then squeeze the entire med back into the minibag and give.

    Now if it was required to have the drug...which I totally don't understand, with sterile water only...why these setups??

    In the ER and in ICUs I have worked in...we hang a bag of NS up in the med room, date it, and use it to draw up for pushes, and medication reconsitution. Also Ancef can be placed in as little as a 50cc bag and is done so in many, many facilities

    Edited...as I remembered something ...that Ancef is the only drug that doesn't come went the above set-up. It comes up pre- mixed by pharmcay. And the person who posted that it's supposed to be reconstitued with at least 10cc of sterile H20/ or BS-H20 is also correct for 500 mgs to 1Gm. for IV Injecction. I guess I should stop jumping into stuff...this late at nite..

    http://www.vetmed.wsu.edu/pharmacy/p.../cefazolin.htm



    http://www.globalrph.com/dilc.htm
    Last edit by Brownms46 on Oct 10, '02
  11. by   whipping girl in 07
    I mix Ancef all the time to send down with the patient to surgery as on-call med. I always use whatever I'm running it in to reconstitute it. As long as it's fully dissolved in a compatible solution it shouldn't matter.
  12. by   Dplear
    Ampicillin needs sterile water to reconstitue with. It will not mix properly with saline or D5 untill it is full liquid form. Aus Nurse is right that many ABX can form micro crystals and cause phelbitis. not enough to cause permenant damage to the patient but enough to cause pain and swelling and redness at the IV site.

    Dave
  13. by   ohbet
    I really love this site, instant feed back and a variety of responses,Thank you. I guess mixing anti-biotics isnt so straight forward as a variety of responses were given on how to do it,thanks again.
  14. by   globalRN
    Originally posted by Dplear
    Ampicillin needs sterile water to reconstitue with. It will not mix properly with saline or D5 untill it is full liquid form. Aus Nurse is right that many ABX can form micro crystals and cause phelbitis. not enough to cause permenant damage to the patient but enough to cause pain and swelling and redness at the IV site.

    Dave
    Dear All:

    I agree with Dplear and Aus Nurse 100%

    If the drug insert from the drug manufacturer says to reconstitute
    with 'X' amount of STERILE WATER and offers no other accceptable substitutes, I don't see why that recommendation isn't followed???

    If other alternative solutions are suggested for RECONSTITUTION, then sure, choose those. However, we shouldn't take it upon ourselves to reconstitute with our solution of choice unless the manufacturer has recommended that. That is taking liberty with drug administration. Just as one would follow the guidelines for taxol or ampho administration(put forth by respective drug manufacturers), why would you follow those guidelines and not guidelines for reconstitution?

    After all, they HAVE studies to back up what they recommend or usually err on the side of caution

    ohbet, as I said earlier : this is not a bonehead question that you are bringing up.
    Last edit by globalRN on Oct 10, '02

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