Published May 14, 2005
Hey everyone, hoping you can help me. We have a new nurse on the unit, she is suggesting diluting gent to a total infusion of 6 cc's. I've never diluted, always followed with a flush thru the med line. Is this a better way of doing things? I'm a little concerned about the volume, especially with diluting amp 2x this way in one day. thanks
Gompers, BSN, RN
I've noticed many level I and II nursery nurses diluting gent that way. No one I know in a level III does because we're so concerned about fluid overload. I'm guessing that they give a more diluted gent in the lower level nurseries to prevent irritation and side effects, since they usually work more with peripheral IVs. Just a guess...
We don't dilute it at all, give it straight 10mg/ml over 30 minutes. We don't give a 30 minute flush afterwards, but I think we should if it's a heplock with no other running fluids, instead of just flushing it SIVP. Usually it's into a running line though, so the maintenance fluids just carry the med in.
Dear Gompers, thanks, I was taught never to give any extra fluids esp. with resp distress. I prime the med line with the gent, and then follow with a 0.6 ml flush. A new grad orienting in the unit asked me if the 6ml dilution was correct. Thanks again!
We dilute it to equal what 30 minutes of their main iv infusion would be. (sorry bad wording) For example if baby had d10w at 10 cc and hour then we dilute it with 5 cc of d10w and run it over 30 minutes, and put the main IV on hold for 30 minutes. We are a level 2. We have vents and CPAPs and some minor surguries but no ECMO major surgery stuff. More like a level 2.5 if there were such a thing
We don't even use Gent anymore--it's always Cef now.
I do think Amp should be diluted more than the directions say--it's very hard on the veins. The kids always cry when it's given.
BittyBabyGrower, MSN, RN
We dilute the Gent to 5mg/ml, and we push it. Our Amp is diluted to 30mg/ml. This is hospital wide for all of peds. if we need, we can have pharmacy make the meds more concentrated if fluids are a really big issue.
dawngloves, BSN, RN
Really? You push Gent? I've only ever pushed Amp and it's usually after a delivery or if the kid is septic or has perforated a bowel.
I've also never diluted Gent. Most of our kids are on TPN and need those electrolytes.
The last time I DID give gent, it was on a pump for 1/2 hour. Don't think pushing it is a great idea--hard on their ears, and other things.
Nope..new guidelines. We use postconceptual age and weight and we only dose qd, q36h or q48h. We also check the levels at the second dose to make sure we are therapeutic. It is believed that the gent's ototoxicity is related to the levels and length of treatment.
That's interesting. We start at Q18 and adjust up or down acording to the third dose peak and trough. Do you have an article I could read?
Our new testing includes peak after the first dose and trough before the second. Interesting... Our gent always runs over 30 minutes and doesn't get further diluted.
We dilute our Gent to 5 mg/ml and give it over 30 minutes on a pump. We never push it. We give Amp over 15 minutes on a pump (100 mg/ml dilution).
Our near-term and term babies start Gent at q18h and get Peak and Trough around the 3rd dose. Our preemies start at q24h and get Peak and Trough around the second dose if they need Gent; we start them on Claforan first since it is less toxic and easier on their kidney function than Gent and then start Gent if a culture shows the baby really needs the Gent.
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