Antibiotics: IV Push vs Infusion

[BonnieSc]

I discovered recently that in my hospital, almost all IV antibiotics are given IV push (the only one everyone could agree had to be infusion was imipenem; typical practice for speed of giving IV push ranged from "instant" to "5 minutes", self-reported). The nurses have to mix infusions themselves. (We are in Africa.)

I'm making a chart showing which antibiotics need to be run as an infusion and the ideal dilution and rate, using information from GlobalRph, but I know they're going to question me. This came up in the first place regarding gentamicin. The nurses in the room all said "We didn't know that," politely, but a doctor said "We've been giving gentamicin IV push for years," with a tone implying I couldn't possibly be right. (Another doctor looked it up and found the information was correct.)

Some of the antibiotics and other drugs list the reasons for infusion over IV push, such as risk of extravasation or seizure, but most don't. What else can I tell the nurses? I have heard that slow infusion gives better coverage than fast, but realized I don't know if that's true.

I never gave an antibiotic IV push before I came here, and never had to dilute my own antibiotics, so I hadn't given much thought to it. I found that the following antibiotics can be given as a slow push: cefazolin, cefotaxime, meropenem, and ampicillin.(For those of you who read my earlier thread about IVs in my adopted country: no, I still haven't been successful in finding a way to institute saline flush. These medications are all being given unflushed.)

[IVRUS, BSN, RN]

Though some IVAB's can be given IV push, many cannot. Medications like Vancomycin and Levaquin are medications which require a timed delivery of at LEAST one hour, and in the case where the Vanc mg amount is over 500mg, then it is normally given over 1.5 to 2 hours. One of your main concerns should be speek shock. Nearly ALL medications have a certain amount of mg/mcg to be given over a certain time frame. The only drug that I know which can be pushed over a few seconds is Adenosine as it has an extremely short half life. In the case of Vancomycin, you need to be worrying about red neck or red man syndrome when it is given too quickly. Gentamycin infusions should be given over 30 minutes to 2 hours. AND ALL lines should be flushed s/p infusion with the appropriate flushing solution.

[BonnieSc]

Thanks for the response. Red man syndrome is regarded as an allergy here, very unfortunately, and also unfortunately, flushing the line is simply not a possibility at this time.

I wasn't familuar with the term "speed shock"--thanks for the input!

[IVRUS, BSN, RN]

Though Red man syndrome "acts" like an allergic reaction with the histamine release, it is NOT a true allergy, and should not be labeled as such. To say that the patient is now allergic to Vancomycin simply because the silly nurse gave this drug too quickly is a shame. Vancomycin is a great drug, but must be administered appropriately.

[bloatedputti, MSN, RN]

The only antibiotic that we push is Ancef. Pushing other antibiotics can lead to anaphylactic reactions, deafness, and renal issues. IF you had no other option, try to use the largest syringe to dilute, and push as slowly as possible, even 30 mins. There are hundreds of drugs that can be IV pushed, antibiotics are generally not pushed.

[gastro_nurse]

Vancomycin should not be pushed due to red man syndrome as the others mentioned.

Gentamicin can safely be pushed. There is no evidence as far as I am aware that kidney/hearing damage is more likely to occur if pushed. However, there is some evidence to show that pushing can be painful

Immediate Post-Administration Safety of Bolus Gentamicin - Roberts - 2