Ok To Use 1/2 Bag Of Premix?

[fostercatmom]

I work for a small rural hospital at night in the ER. We only have pharmacy open during the day. The new pharmacy director has decreed the house supervisors may not go into the pharmacy for anything but absolutely life and death meds.

The other night in the ER, My LPN needed Vanco 500mg. The ICU and us only had 1000 mg premixed bags. I said it was ok to use half the bag, ie set the pump to 125 cc volume limit. The LPN , strenuously disagreed. ICU agreed with me, the MD's, and the house supervisor agreed with me. Yes, the bags are not exactly 250 cc, but it would be close enough and it was more important for the patient to get something rather than nothing for 8 hours.

What do you think? I hate to think I've been worng all these years....

Thanks

[CritterLover, BSN, RN]

have to agree with you. can't quite figure out why you wouldn't want to give 1/2 bag of premix. probably more accurate than when the pharmacy tech reconstituted the vial of abx, then injected the hopefully correct amount of drug into the bag of hopefully compatable fluid, and did it all (hopefully) with sterile technique.

not trying to put-down pharmacy techs. they are usually very good at their job. but, like nurses, they make mistakes. i'm just trying to point out that the ad-mix process has many places were errors can occur, and you would never know it. at least when you are giving a half-bag of premix, the volume is the only issue.

i work some at an outpatient infusion center, where the drugs are mixed at a pharmacy several miles away. if we get a last-minute dosage change (say a decrease in the vanc dose due to a high trough level), we will often calculate out the correct amout of the bag that should be given, until new bags can be mixed for the next day. say i have a patient that is getting 1 gm of vanc a day, in 200 cc. i draw a trough level on monday. for some reason, the results arn't back later that day. so i will call tuesday morning before i give the dose. i find out the trough is elevated, maybe 15. we call the doc, who doesn't want to hold a dose, but wants to decrease it to 750 mg daily. the only bags i have are 1gm bags. it will take several hours to get the new dose. it only makes sence to give 3/4 of the old bag (150 cc), rather than wait hours for a new bag to be delivered. this scenerio doesn't happen often, since we usually get our trough levels back the day they are drawn, but every once in a while there is a delay at the lab and this kind of thing ends up happening. never even thought it was a big deal.