Bicillin Dose

[janat]

I work for a Dr. who treats a lot of Lyme patients. For some patients, the Dr. has prescribed IM Bicillin LA, in weekly doses. Usually the dose is 1.2M units, but for others, the Dr. has increased the dose to 2.4M units per week. The Dr. prefers that the the 2.4M dose is given in a single injection, all in one buttock. His reasoning is that while it is a large injection, it is easier on the patient overall rather than splitting into two sites, since the injections can be alternated between buttocks every other week. The manufacter supplies the 2.4M Bicillin dose in a 4cc volume, and a disposable syringe with an 18g 2 inch needle. Adminstering this volume with this needle has been a pretty uncomfortable experience for most of my patients.

Does anyone have experience with the 2.4M dose vs. splitting the dose into two sites?

Thanks.

[TazziRN, RN]

It doesn't matter what the solution being injected is, you should never inject more than three mls in one buttock. 2 is preferable, 3 is acceptable, no more.

[clee1]

It doesn't matter what the solution being injected is, you should never inject more than three mls in one buttock. 2 is preferable, 3 is acceptable, no more.

Exactly right.

NO MORE than three ml in an IM site.

[TazziRN, RN]

'Nuther thing: I have found that the needles on the prefilled syringes are actually duller than detachable needles. I inject the solution into another syringe, attach another needle, and off I go.

[janat]

Thanks for the response.

Some people have said that since the mfg makes a 4ml pre-filled syringe, then it must be okay to give that much in one site.

I will see if the Dr. will agree to divide into two sites. Even a 2ml Bicillin shot is painful. 4ml is really uncomfortable for most patients.

[TazziRN, RN]

Go with what you were taught in school. Just because the manufacturer supplies it that way doesn't make it right.

[gauge14iv, MSN, APRN, NP]

Only problem with changing needles on bicillin is that the end of the prefill needle which is inside the syringe has a small curve in it which brings it close to the glass. This way when you aspirate, if any blood were to come back, it would come up against the glass and you would see it. On a standard needle this would not happen - the aspirated blood would come up in the middle of the bicillin where it would be invisible and then the bicillin could accidentally be injected IV leading to immediate cardiorespiratory arrest and death.

That is a safety measure the manufacturer has provided - I wouldn't advise disposing of that - see this FDA advisory for further information - there is a diagram on page 2 that explains it:

http://www.fda.gov/medwatch/safety/2005/Nov_PI/Bicillin%20LA%20Tubex_PI.pdf

[TazziRN, RN]

Harpoon, my friend!!!

I was not aware of that......hmm......gotta rethink this.......

[gauge14iv, MSN, APRN, NP]

I change out the needle/syringes on a LOT of prefills - but not bicillin :)

I agree that the needles are just torturously dull on those suckers.

[txspadequeenRN, BSN, RN]

:eek::eek: Holy Cow :eek::eek:

18g 2 inch needle.