No more piggybacking zosyn? - page 2

by RENEfromLA

7,345 Views | 19 Comments

A new policy at our hospital states that we cannot piggyback zosyn ...this may be a dumb question (I am a brand new nurse so bear with me) but WHY NOT? WHY CAN'T WE? Please let me hear your reason. THANK YOU ALL!... Read More


  1. 6
    While it's given over a longer period of time, it's still an intermittent infusion. Our policy is to still use a primary "flush bag" although we use one that's separate from whatever IVF are running. We run the infusion continuously at 12.5 ml/hr and hang a 50 cc bag of zosyn every 4 hours, with the "flush bag" NS running in between.

    We initially were running it as a primary but found too much zosyn was being wasted priming the bag and then removing air if the drip chamber emptied between doses (at times about 20cc was being wasted, or almost half the dose). Setting it up as a secondary allows for the NS to be wasted in the sink rather than the zosyn and keeps the line primed between doses rather than setting the pump volume low so that you don't suck the bag dry, or emptying the bag which causes more waste of antibiotic when you re-prime the line.
    delilas, Aurora77, EverNurseRN, and 3 others like this.
  2. 0
    Quote from Esme12
    There are new studies that Zosyn is more effective if given over an extended peroid of time every eight hours therefore it is no longer a "piggyback"but a continous infusion.

    http://www.nebraskamed.com/App_Files...col-detail.pdf
    http://www.rsfh.com/portal/RSFHEIZos...nfirstpage.pdf
    Thank you!! At my old hospital it could not be piggybacked and was to run in at 25/hr, and no one could ever state any rationale for this and I couldn't find any. Where I work now it's piggybacked and given q6 at 100/hr.
  3. 2
    Quote from CharlieTaco
    Zoysn is supposed to be run over a four hour period. This is a new policy since most people used to run it as a rapid infusion 15-30mins. If your running it over 4 hours twice a day, what ever fluid is on the primary line would now be paused for a total of at least 8 hours a day.
    Thats why you can run fluids concurrently. Eliminating that problem.
    KelRN215 and MN-Nurse like this.
  4. 0
    We run Zosyn on a microinfuser, not as a piggyback. I think ER does run it as piggyback. The microinfuser tubing is very thin so I doubt much gets wasted whether it's run as a primary or on a Y-port. And like other's I never heard of it being run over 4 hours. I have pt's that i have to give tons of abx and 4 hrs wouldn't allow for everything to be given, especially if they're also on electrolyte protocols!
  5. 0
    what esme said...
  6. 0
    We are running it over hours mostly. I run it as a piggyback, but yes, that would lower any maintenance fluids being received. If I was concerned about that, I would run a flush bag into the primary fluid line and piggyback the Zosyn on the flush bag.

    PS - If there are so many ABX or whatever, that need to be run (blood products, lytes replacement, etc) I'll start another line if possible.
  7. 0
    When running over 4 hrs, I can see why they do not want you to piggyback it (having the primary fluids not running for 4 hours at a time while the Zosyn in running). However, you could always piggyback it into KVO fluids, Y site this into the primary fluids, which would run through the entire infusion.

    On a side note, in our ER we can still run Zosyn over 30 minutes (it is 4 hours on the floor). Policy is that we supposed to piggyback it, but many nurses run it as a primary.
  8. 0
    Interesting. Like a 80mg protonix drip as opposed to 40 mg ivp BID. Wonder if they'll end up creating special "drip" protocols where I work....
  9. 0
    We typically run a loading dose of 2.25gm then a continuous infusion at 8.3cc/hr after the loading dose.
  10. 0
    Our hospital also went to 4 hour infusion time every 6-8 hours on for 4 off 2 hrs or on 4 off 4hrs, it is renal dosing. best practice medication is more effective and easier on the kidneys. we connect it to a maintence fluid at the Y site under the pump because the infusion only runs at 12.5ml/hr. also in the ER and the first dose can be given over 30min considered a loading dose, then all other doses run at extended infusion.
    Last edit by CandaceHinz on Jul 12, '12


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