Do you give mag off pump?

MassED, BSN, RN · May 1, 2012

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?

No. Usually on a mini-infuser if given as a bolus.

MassED, BSN, RN · May 1, 2012

The 20g bag was made by pharmacy and sent up. It had to do with how the doc ordered it. They order on the computer and I believe it came up as Magnesium sulfate: 20gm in 500cc, dose [to give] 2000mg. In the ER, the nurse calls down for meds that we don't have loaded or premixed. So they don't see the doctor's order, just what the nurse tells them.

WhAT? They don't see the doctor's ORDER? How can they verify that the drug is appropriately ordered? No way! Their butt would be on the line if something happened... well i guess it already did with the Mag order. You certainly cannot always trust the pharmacist. Always double check them!

MassED, BSN, RN · May 1, 2012

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.

That's a new infusion for Zosyn. We just started this too. That is for AFTER the first dose of Zosyn given over 30 minutes.

Guest219794 · May 2, 2012

That's a new infusion for Zosyn. We just started this too. That is for AFTER the first dose of Zosyn given over 30 minutes.

A bit of a thread hijack, but seems better than starting a new thread. Both you and another poster referred to an intitial dose run over 1/2 hour prior to switching to the continuous infusion deal.

Got any literature on that practice? We just switched to the long infusions. It would be nice if there was some evidence that in the ER, we could stick with the short infusion time, then stick the floor with the problem of the long infusions.

MassED, BSN, RN · May 2, 2012

A bit of a thread hijack, but seems better than starting a new thread. Both you and another poster referred to an intitial dose run over 1/2 hour prior to switching to the continuous infusion deal.
Got any literature on that practice? We just switched to the long infusions. It would be nice if there was some evidence that in the ER, we could stick with the short infusion time, then stick the floor with the problem of the long infusions.

here's one source. We still start out with the first dose at 30 minutes, as usual. 6 hours later they get a 4 hour infusion. Sometimes they are still in the ED, but hopefully not.

http://www.nebraskamed.com/app_files/pdf/careers/education-programs/asp/pip-tazoei-protocol-detail.pdf?v=2

psu_213, BSN, RN · May 2, 2012

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.

I asked our unit pharmacist about it. It has to do with the MIC of zosyn, and that if it is given over 30 minutes, its level in the blood will not be optimal for as long as if the dose is given over 4 hrs. Our pharmacist 'got permission' for the ER to continue giving our zosyn over 30 min, even though it is now 4 hrs for inpatients.

rgroyer1RNBSN, BSN, RN · May 2, 2012

Yeah we are on the 4 hour zosyn infusion to. God on the mag you have to watch closely as to much can paralyze pts diaphram the only time I give it off the pump is occasionally in an extreme emergency the doc will order it iv push.

BellaInBlueScrubsRN · May 5, 2012

That's really interesting! We use it mainly for pains and such.

on_the_move · May 7, 2012

I've only given Mag wide open in asthma/resp distress and codes. Dose was always 2g.