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bumex drip administration

Posted

I've tried to research this and wasn't able to find a clear cut answer. I had a patient today that was started on a bumex drip. The drip was to be run at 1 mg/hr (4 cc/hr). Since it was running so slowly, I added NS at 6 cc/hr to run concurrently so that the total administration would be at KVO. The patient had a fluid restriction, but was nowhere close to going over the amount and I included the amount of NS in the I&O log. When giving my handoff report, the other nurse told me that she would need to take down the saline and that NS should never be run with bumex and that, if the IV occludes due to the slow rate, you just have to flush it. I know that bumex is compatible with NS so I don't understand why it would be a big deal, so long as the patient didn't feel "deprived" of PO fluids or go over their fluid restriction. I just want to be better educated about whether it is better practice to run slow fluids with NS to KVO or leave the drips as ordered, even if only at 4 cc/hr. Is there another rationale behind why people use NS with other slow drips?

iluvivt, BSN, RN

Specializes in Infusion Nursing, Home Health Infusion. Has 32 years experience.

Start with this: http://biomed.partners.org/main/NewsItems/IVInfusionArticle.pdf

I am thinking maybe this was their concern!

What you want to consider is the interaction among intravenous tubing design, infusion pumps, and carrier flow rates regarding timing of actual drug delivery. Studies have examined the interactions of dead space volumes and carrier rates on the time lag to initial drug delivery and time to steady-state drug delivery (I posted one above). These interactions will vary whenever a change in carrier flow rate occurs so when there is a slow carrier rate and then it is suddenly increased, this will result in a bolus of drug. When a rapid carrier rate is suddenly reduced, this will result in a marked reduction in drug delivery.

You can keep a CVC open with a KVO rate of .1-.2ml and hour we do it all the time in home care and these are are PICC lines so you Bumex drip does not neccesaarly need a carrier fluid. Can it still back up and clot off...sure it can!

Edited by iluvivt

MunoRN, RN

Specializes in Critical Care. Has 10 years experience.

Our facility policy is to supplement drips with a carrier fluid to get at least 10ml/hr running through the line. This isn't so much to keep it open as it is to deal with various other issues. One is that a carrier fluid prevents deals with the issue of delayed occlusion alarms with a slow rate, which can result in patients getting a significantly reduced overall dose of medication. With titrated drips it facilitates quicker response between dose changes and when that change actually hits the patient. It also helps avoid the issue of the bolus/delay that happens when the IV is assessed with a manual flush.

A basic rule of all carrier fluids is that they need to remain at a constant rate, so I see illuvit's point, but I think it makes a lot more sense to simply educate people that the rate must remain constant, rather than just lose the benefits of a carrier fluid to avoid a rather easy teaching topic.

SierraBravo

Has 3 years experience.

Start with this: http://biomed.partners.org/main/NewsItems/IVInfusionArticle.pdf

I am thinking maybe this was their concern!

What you want to consider is the interaction among intravenous tubing design, infusion pumps, and carrier flow rates regarding timing of actual drug delivery. Studies have examined the interactions of dead space volumes and carrier rates on the time lag to initial drug delivery and time to steady-state drug delivery (I posted one above). These interactions will vary whenever a change in carrier flow rate occurs so when there is a slow carrier rate and then it is suddenly increased, this will result in a bolus of drug. When a rapid carrier rate is suddenly reduced, this will result in a marked reduction in drug delivery.

You can keep a CVC open with a KVO rate of .1-.2ml and hour we do it all the time in home care and these are are PICC lines so you Bumex drip does not neccesaarly need a carrier fluid. Can it still back up and clot off...sure it can!

With all due respect, I don't understand how running NS at 0.1-0.2mL/hr. can keep a CVC patent. Our institutional policy states that peripheral IV's need at least 5mL/hr. to KVO, and CVC's need at least 10mL/hr. to KVO.

iluvivt, BSN, RN

Specializes in Infusion Nursing, Home Health Infusion. Has 32 years experience.

There is what research says and then there is policy and what clinicians actually do and see in their work setting. There is no research that verifies what rate will maintain patency of any catheter or vein. This is because there are way too many variables that effect the catheters and the veins ability to stay patent. Some of these variables include tip location, procedures such as high pressure injections, rapid forceful flushing, type of pump being used and its PSI setting and ability to change that, hydration status, coagulation factors, flushing techniques, nursing care provided such as not flushing on time or leaving an empty IV bag up and hanging for too long and how the IV system is set up.

I can tell you that for as long as I have been doing Home IV infusion we set up 2 day to 7 day IV bags, The pumps are set to deliver the prescribed does of whatever (usually an antibiotic) at the prescribed interval,usually every 6 to 8 hours. Then in between it is set to deliver .1 to .2 ml per hour to keep the line and vein open, These are mostly on PICCs which are longer type lines. I have seen this on any and all types of CVCs and they stay open so it does work. When the bag or cassette is changed you do have to flush since you are disconnecting the tubing and it takes some time to set up another system. The patient never interrupts the infusion unless there is an issue and never flushes it until the bag change.

I was just guessing on what the PP was wondering about as the concern or issue was not clearly identified, This issue is most important in the neonatal and pediatric populations and if carrier rates are changed without thinking..

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I just want to clarify that I did not change the rate. The drip was ordered during my shift, so I initially set it up with the NS carrier. So it wasn't suddenly changed, really, until the other nurse took the carrier down. I guess I just imagine it would be more beneficial to get your medicine consistently even if you get 6cc of fluid every hour, than to have it clot off, wait for the nurse to get there to flush it, get a bolus of medication when they flush, then wait for it to clot off again.

Esme12, ASN, BSN, RN

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma. Has 40 years experience.

My feeling....even at 4 cc/hr they carried has little effect on the delivery of the drug or the patency of the IV. The issue here is extra fluid.

I would have not hung extra fluid.

The drug in itself is a extremely strong loop diuretic. For every 1mg delivered is equivalent to 40 mg of lasix. That being said if your patient is being placed on a bumex drip as opposed to lasix, the provider is looking for a greater output in a quick response time. Adding any additional fluids would be contraindicated. As the prior response from some one else, they were correct in saying that currently there is no evidence that supports KVO as it relates to clotting and time.