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!

[DebblesRN, ASN, BSN, RN]

I work in a level II NICU and we use syringe pumps and microtubing for antibiotic infusion for ALL babies, regardless of their weight. The company that was selling new pumps to the hospital came in and tried to argue with the neonatologists and the nurse manager that syringe pumps weren't necessary, you can piggyback the fluids. Ha Ha. Seriously, when you start dopamine on a baby and it takes 2 hours for the baby to get any of the drug because of the rate of the primary line plus the size of the tubing--they finally shut up. We got to keep our syringe pumps.

I agree with a previous poster. If the hospital is unwilling to invest in a few syringe pumps, they don't need to be caring for ANY baby. You never know when your full term baby will need dopamine NOW--not in two hours.

[Carrybee]

This particular co has an unwritten policy that they cannot replace syringe pumps. I can see how someone without a clinical background might not understand of the potential harm to a small baby. Having only worked with adults I had no idea that it might take 2-3 hrs for the baby to receive meds via a secondary port. It is just very surprising that this would not be a requirement - this is not the first Nicu that does not have syringe pumps.

[littleneoRN]

Our pressors run in bags, but they runto a trifuse right at the bottom by the baby. I've never piggy backed anything. I'm not sure how one would piggy back antibiotics on a large volume pump unless it cam in a bag too. Might small bag of Ampicillin for 750 gm kiddo.

[littleneoRN]

Also, babies are more sensitive to fast infusion rates. We give a lot of meds over 15 to 30 minutes that you would push on adults. Lasix, morphine, etc. Not sure what other places do. We run these on a syring pump. We don't hand flush anything at all into our little 26 g PICCs. Even push type meds use a pump over a few minutes as these lines don't withstand pressure well.

[Carrybee]

This pump can deliver meds/antibiotics by a syringe via the secondary port. The issue of course is the 8 ml of dead space.

[Carrybee]

Wow very informative. Thanks for the information. I'm not sure what level Nicu this is but I was told some babies are vented.

[DebblesRN, ASN, BSN, RN]

We use the abbott plum triple pumps for maintenance fluid with a buretrol. There is a cartridge that inserts into the pump and there is a piggyback port there that you can either hook a syringe or a bag with tubing to, in order to piggyback your drugs. We don't use them. Any drugs we give like bicarb, antibiotics, dopamine, lasix, etc. are given via syringe pump at the distal port of the maintenance tubing.

[NICU_babyRN, BSN, RN]

Any baby, any size is getting meds delivered via syringe pump. VERY few meds are given IV push. The hospital in question here really has to change their policy.

[NicuGal, MSN, RN]

Wow is all I can say....every major institution I know of uses syringes pumps. If they aren't going to invest in syringe pumps they need to come up with a better set up. I wonder if they can use a trifurcated filiter that has a med port on it and infuse there with the pumps they have, at least it would be closer to the baby with only about 0.8ml deadspace. Do they have syringe set ups for the pumps....I can't for the life of me figure out how they do this. Sorry, but that sounds like a mistake waiting to happen, esp if they are caring for micronates!

[dawngloves, BSN, RN]

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?

Even Vanco and Ampho?? I hope not!

I've been in NICU for 10 years and have always used syringes to administer IV meds. Any facility that doesn't needs to update, IMO.