Do you give mag off pump?

[BellaInBlueScrubsRN]

In the ER I work at, its common to put 2g magnesium sulfate IVPB onto gravity. As a bolus. I had it in my head that the idea was 1g/hr. Recently, there was a mistake and 20g of mag, instead of 2g, was hung, wide open. Luckily it was caught before even 1/3 of the bag was in.

Is it common to give it off pump, pretty much as a bolus?

[Robublind]

Personally, the pumps we have in our hosp are pretty quick to use so I tend to put most of my IVs and piggy backs on pumps.

If I have mag in a 1L banana bag I will run it to gravity. It is easier to control the rate and give it over a hour. But the mag by itself in a small bag, I always run on a pump. Too easy to bolus a 50ml bag in a couple minutes without a pump.

20g bag yikes!

[MelEpiRN]

We're changing to the 4 hour time on Zosyn too. I forget the details, but it absorbs/ works better if infused over 4 hours. I suspect it will catch on elsewhere soon.

[rjflyn, ASN, RN]

Generally 2G hour on pump is the limit unless its 1) OB for pregnancy induced hypertension/ and its complications, 2) asthma. On Zosyn our facility too has gone to the hour time frame save for the ED we still do 30 minutes because ED doctors generally order more than one antibiotic. To meet the standard, for example in the case of pneumonia all the antibiotics have to be given and if there is a miss you miss the indicator and we are not going to keep a pt in the ED an extra 4 hours just to start a second med, as the floors have a tendency to miss them for us.

[PediLove2147, BSN, RN]

We give Mag all the time, always on a pump over 30 minutes.

Our hospital also gives Zosyn over 4 hours, for that reason I don't see it given too often.

[KelRN215, BSN, RN]

When I worked in the hospital, mag boluses were given over 2 hours with VS done every 30 minutes.

I have only ever given Zosyn over 30 minutes. Can't imagine giving it over 4 hours... especially with the doses they're on in pediatrics- they'd end up getting like 3 mL/hr. (I don't remember the concentration that pharmacy reconstitutes Zosyn too, bit I remember it usually came in relatively small syringes.) Not to mention, zosyn was never a first line antibiotic for my patients and if they were on it, they were usually also on Vanco and Ceftaz so these poor kids would end up hooked up to some antibiotic 24/7 if Zosyn was a 4 hour thing.

[Anna Flaxis, BSN, RN]

4hrs?! Wow, why the change? Manufacturer? We still run ours in over 30 min. Longest abx we run in takes 2 hours (vanc, etc). 4 hrs is crazy; as much as we use zosyn, we would def have to change meds.

It's because by increasing the infusion time to four hours, the concentration remains above the minimum inhibitory concentration for a greater period of time, and dosage can be changed from Q6hours to Q8hours. It's what all the cool kids are doing these days.

[Anna Flaxis, BSN, RN]

I've never given mag by gravity, but I've only given it for ventricular arrhythmia, and we have a standard protocol that requires using a pump.

[ckh23, BSN, RN]

4hrs?! Wow, why the change? Manufacturer? We still run ours in over 30 min. Longest abx we run in takes 2 hours (vanc, etc). 4 hrs is crazy; as much as we use zosyn, we would def have to change meds.

It has to do with efficacy and how fast it is eliminated by the kidneys. Our protocol is over 4 hours unless they are on dialysis, in which case we still give it over 30 minutes.

[SMARN]

It's because by increasing the infusion time to four hours, the concentration remains above the minimum inhibitory concentration for a greater period of time, and dosage can be changed from Q6hours to Q8hours. It's what all the cool kids are doing these days.

Well, I read about it on the FDA site and didn't see much info pertaining to increased efficacy with longer infusion times.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1635208/

The above research study didn't show any benefits to the patient on continuous infusions vs intermittent, similar to the 30-min vs 4-hr infusion times.

I'm glad we still run it in over 30min. :)

[thelema13]

The PharmD found a research study that clearly demonstrated that asthma patients who are given 2g Mag as an IV bolus were less likely to be intubated and die as a result of their asthma attack. I run it our 50 mL bags of 2g as fast as I can in someone with respiratory distress and I do it gleefully!! Breathe!

We give 2g mag as a bolus infusion for asthma attacks as well. Has something to do with stabilizing the mucous membranes in the lungs and reverses bronchospasm, if I remember correctly. Of course pt is on a cardiac monitor.

Zosyn for 4 hrs? Crazy. We run for 30 mins. All abx go on a pump, except I run rocephin off gravity, no biggie since you can give rocephin IVP over 2-3 minutes.

[Anna Flaxis, BSN, RN]

The above research study didn't show any benefits to the patient on continuous infusions vs intermittent, similar to the 30-min vs 4-hr infusion times.

I'm glad we still run it in over 30min. :)

It didn't show any benefit of 30minute infusion times over continuous, either, and in fact, by running it continuously, you can decrease the costs associated with its administration.

The four hour infusion time doesn't "increase efficacy", but rather, keeps the concentration of drug in the blood stream above the MIC for a greater period of time, and permits q8 hour dosing, reducing the overall 24 hour dose.

[thelema13]

So, Zosyn on floor for 4 hours, Zosyn in ED for 30 mins.