Antibiotic bone head question

[ohbet]

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.

[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.

[pebbles, BSN, RN]

Also, whoever said that they keep an IV bag in the med room to use for reconstitution... be aware that this is not recommended any more because of the risks of cross-contamination.

We have vials of NS and sterile H2O in the med room... I use 10 cc sterile H2O for most of my med reconstitution, unless specified otherwise. I think the only one we *have* to use saline for is Imipenum, which we don't use that often any more. H2O is a safe choice in most cases. (We still use buretrols, so there is no separate bag that it will be injected in to. Otherwise I would say it would be safe to draw the solution for reconstitution from the mini-bag)

I think the manufacturer assumes that you will be reconstituting the med into a liquid form, THEN diluting it further (in a mini-bag of 100 ml, for example). Anyway, that is what I was taught to do in school as well. Most antibitics are not safe to give just in the 10cc of reconstituted liquid, they have to be further diluted. But you have to reconstitute it to be able to add it to a larger amount of fluid for administration. Hence the two steps of instructions.

[globalRN]

Originally posted by pebbles

Yes, I have seen the common IV bag used for reconstitution and I don't like that practice one bit for the reason stated above.

As a former nursing instructor, that is exactly what I taught.

[mario_ragucci]

As a first year/haven't completed syringe LAB yet, this thread blows me completely away. Boom! I've seen RN's shaking IV (parenteral) meds...now I know...a little...thanks to you (excellent seeds)

[aus nurse]

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

Ah thankyou Dave, you explained it much better than me:)

[rmn]

Your prob was way over my head. Three months into training and the Staff Nurse on my current ward was so unhelpful yesterday when I ask what type of water I should use to reconstitute a bottle of cephelexin that she refused to just advise me and insists that I should know the answer by my next shift! Help!:imbar

[canoehead, BSN, RN]

There is only one type of water that I know of for IV drugs- sterile.

What else could you mean?

[LydiaGreen]

In the hospital I am doing my consolidation in in Ontario we have ONE source for information on how to mix IV meds... The Ottawa Civic Manual. It is our Bible for IV meds and it is the one to be followed, not a drug reference guide, not the manufacturer's instructions. Only the manual. Most IV meds (coming in IV form from the manufacturers) are designed to be mixed in the IV minibag you are using through the use of a reconstitution device. These dissolve immediately. There are a few exceptions that require a longer time to dissolve completely and for those we fill the bottle the med came in and allow it to sit for awhile (sometimes as long as an hour) to dissolve before squeezing it into the minibag.

[zacarias, ASN, RN]

Hey all,

I'm amazed to see all these posters who reconstitute antibiotics. I SELDOM EVER reconstitute anything at my large teaching hospital. All our abx are premixed and ready to hang piggybacked to an appropriate solution (NS etc...) Am I missing something or are you all in small hospitals? :)

[rmn]

Mixing a bottle of ceflex with non-specific instructions for adding '60mls of water and shake mixture'

It's an organic psychy placement in UK. They dont have any other procedure files relating to mixing meds. Unable to access anything on KA24 as yet but still surfing. Nothing on general www except for IV recon advice. Last resort is contact pharmacy as I felt nursing staff would be just as helpful. No clinical Lit covers this specific area in Ward Library for students. I'll post any info and reference documents I get so that others may benefit.