Stop the insanity!!

  1. This question is in one of my books and it puzzeled me for quite some time.

    Your patient has vancomycin 1 g IV ordered for 0900 hours. The pharmecy sends up a 250-cc bag with 1 g of vancomycin, to infuse over one hour. Your IV drip rate is 10drops/cc. You calculate and regulate the IV rate at 42 drops per min. When you return 30 min later the entire 250 cc has infused into the patient and he appears very flushed and complains of feeling hot.

    How Can You Avoid This Med Error?

    OK my guess is that as far as I can tell the IV infusion rate is fine so the question is Why did it infuse faster? Regardless of the reason is the answer: "Check the IV sooner than 30 min?
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  2. 11 Comments

  3. by   tribe0701
    Run the IV through a pump instead of to gravity, it is more controlled.
  4. by   TexasNS
    That would probably be better. Sometimes I swear I over think things way to often.

    Now if a pump was not available??
  5. by   colleen10
    I'm confused about one thing with the question.

    Is the 250mL to be run over 9 hours, or 1 hour?

    Or do they mean 0900hours = 9:00AM?
    Last edit by colleen10 on Mar 5, '04
  6. by   rpbear
    0900 hrs is 9:00 AM military time. A lot of hospitals are now on military time.

    If there were no pump available then I would say to check the IV after five minutes of infusing to make sure that it is not running in too fast.
  7. by   TexasNS
    See and that is what I thought before i started overthinking lol

    Thanks
  8. by   foreverhope
    Reposition patients arm and double check rate before leaving the room and then check again in 5 or 10 minutes. (The hospital I do clinicals at is not replacing their pumps as they break, so eventually will all be gravity. Our instructors are teaching us to take some extra precautions to avoid what the question above described.)
  9. by   Ortho_RN
    I have never seen Vanc ran only for 1hr... When we run it we run it at 85cc/hr, and its a 250cc bag.. So it takes almost 3hrs to run... 1hr seems awfully fast for Vanc
  10. by   AmyB
    Seems like we are using the same book. Our instructor stressed that if vancomycin is given too quickly, a reaction like that might happen. Intervention was to stick around for 10-15 and watch for adverse reactions.
  11. by   Mithrah
    Quote from AmyB
    Seems like we are using the same book. Our instructor stressed that if vancomycin is given too quickly, a reaction like that might happen. Intervention was to stick around for 10-15 and watch for adverse reactions.

    Vancomycin can cause Red Man Syndrome. To help prevent it, it should be given slowly over 60 minutes. For volumes greater than 1000mg it should be given over 90 minutes.
    Last edit by Mithrah on Mar 5, '04
  12. by   chiefswife
    What about checking the IV site (prior to hanging the bag) for s/sx of infiltration? If the IV site was bad in the first place, the IV would need to be restarted prior to hanging the new bag with or without the Vanc.

    Just my $.02
  13. by   unknown99
    We run vancomycin IV in 100ml saline over one hour via infusion pump. We never do gravity with vanco because of nephrotoxicity possibility. That's the policy where I work.

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