Antiobiotic delivery via iv pump in NICU

[Carrybee]

Hi! Can you please tell me how you deliver iv antibiotics in the NICU if your hospital only uses large volume iv pumps (no syringe pumps)? Piggyback port? What is a typical rate? After infusing the antibiotic do you flush the line with additional flush to accommodate the dead space in the tubing? Thank you!

[xtxrn, ASN, RN]

What is the policy at the facility in question?

[gigglymo]

I'm going to agree with the PP here - follow policy. :)

[Carrybee]

Thank you! I am in the ccu and also work per diem for an iv company but have no previous experience in the Nicu. The question of how to deliver antibiotics came up in class. The length of this tubing is about 8 ml. I just wanted to know how hospitals without syringe pumps deliver antibiotics so that they can obtain therapeutic antibiotic levels while not fluid overloading the babies.

[NeoPediRN]

We use Plum pumps with standard IV and secondary tubing. The secondary line connects to a clave by the pump door where the primary tubing goes. The rate depends on the antibiotic. We set the primary line for a flush or flush manually. If it's a cardiac kiddo or one sensitive to volume then we would hook up the antibiotic as the primary line and manually flush after. We can also give certain abx IM and do that if the volume is that much of an issue, but it generally isn't.

[Carrybee]

But you infuse it this way to a Nicu baby that might only be 750 Grams?

[NeoPediRN]

We get bigger babies than that, but a baby that small would need a syringe pump.

[Carrybee]

I completely agree but unfortunately this hospital does not use syringe pumps. Just trying to guide them in the best direction to ensure therapeutic antibiotic levels. I thought perhaps some nicu's might allow slow iv push of antibiotics via the distal port?

[littleneoRN]

Syringe pumps are necessary equipment for any hospital caring for a 750 gram baby. I know it's not your choice, but a hospital that won't invest in a few syringe pumps doesn't have business caring for micropreemies.

[littleneoRN]

PS...8 mL of tubing length is probably 2-3 hours worth of fluid for that size baby, so it will take a long time for the med to actually reach the baby.

[Carrybee]

Not sure why they didn't also purchase syringe pumps. They are less expensive and more accurate. The accuracy of these pumps drops from +_5% to +_ 10% if they are infusing at rates below 1 ml/hr.

[Carrybee]

Interesting story by one of the nurse instructors. A hospital transitioned to these new iv pumps. They had been using baxter iv pumps and Baxter syringe pumps. Following the implementation the hospital took away the syringe pumps. A neonatologist called this nurse to report issues with achieving therapeutic ab levels. The nurse had to tell him that the new iv pumps cannot replace the syringes. Fortunately the hospital reinstated the syringes.