Giving abx in 100 ml NS instead of 50 ml

[autumn_blue]

Went to give an expensive antibiotic, accidentally grabbed a 100ml bag of NS the other day instead of a 50ml bag. Replaced it, but was thinking ... this particular patient needs more fluids, not less (kidney patient). Would it actually hurt them to run an abx at 100ml/hour over an hour vs 100ml/hr over 30 minutes and give them 50 more ml of NS? I'm thinking it would have been fine.

[jobellestarr]

It could. If I was going to use a 100 ml bag when the dosing is for 50 ml, I would hook up the bag to tubing and run out 50 ml. Some patients are on strict fluid restrictions/precautions. I’m a transplant nurse and it can make a difference to kidney and liver patients. And of course, to peds. 

[MunoRN, RN]

6 hours ago, jobellestarr said:

It could. If I was going to use a 100 ml bag when the dosing is for 50 ml, I would hook up the bag to tubing and run out 50 ml. Some patients are on strict fluid restrictions/precautions. I’m a transplant nurse and it can make a difference to kidney and liver patients. And of course, to peds. 

50 ml isn't the dose, if for instance the order is for 2 grams of cefazolin then 2 grams is the dose.  If the antibiotic was 2 grams in 100ml instead of 50 mls then giving 50 mls would be giving half the dose.

[jobellestarr]

Huh? Duh. I’m talking about fluid. I wouldn’t have mixed the dose in 100 ml and then empty 50 ml. Good grief. 

[Hannahbanana, BSN, MSN]

The amount or type of the diluent isn't as important as the time frame over which it is run. Xmg/30 minutes, whether Xmg is in 50cc or 100 cc or 250cc, that's what ID cares about for serum concentration and/or renal or other toxicity. As to the total amount of fluid for the patient, if the doc writes for maintenance fluids at, say, 125cc/hr, then the doc expects the patient will get 24 x 125cc/24hours, or 3000 cc/24 hrs.

[DavidFR, BSN, MSN, RN]

I totally don't get the issue here. Do doctors prescribe your ways of administration as well as the dose and the route in the US? Unacceptable for a European nurse that a doctor tells you how to administer your IVs. Not their job and not their business.

In the two countries I've worked in (UK and France) a doctor prescribes "Augmentin 1g IV x 3 per day" The timing and the ways you administer are nursing decisions and provided the patient gets 1g every 8 hours in a safe, accepted way, nobody is going to quibble over 50cc of saline. Your choice if you use 50cc  or 100cc. Equally your choice if you use normal saline or 5% Glucose provided the drug is compatible. Often you'll adapt that to the clinincal situation - for example I wouldn't use 5% Glucose for a diabetic but I may well favour it over saline for somebody at risk of heart failure.

Many antibiotics in the UK that can be given as a bolus are given that way, for example Amoxicillin, Augmentin, Cefotaxime (dilute in 10cc of water for injections and give slowly over 5 - 6 mins.) Not so common in France but I will still do it for patients who need fluids restricted or who are on lots of IVs (haematology patients for example) giving them a significant IV input.

I actually prefer the bolus route where possible, not just because I was trained with it in the UK but also because it gives you an excuse to sit down and talk to your patient for a few minutes. Also if they have a reaction, they do it there in front of your eyes whereas once you've hung a bag, you've usually left the room when they react.

[JKL33]

13 hours ago, DavidFR said:

Do doctors prescribe your ways of administration as well as the dose and the route in the US? Unacceptable for a European nurse that a doctor tells you how to administer your IVs. Not their job and not their business.

No it is not a doctor vs. nurse thing. They couldn't care less how we administer the therapy.

It is due to extraneous business issues not directly related to either doctors or nurses, such as hospital billing, payment for services, supply chains, etc.

[DavidFR, BSN, MSN, RN]

On 10/10/2021 at 3:16 PM, JKL33 said:

No it is not a doctor vs. nurse thing. They couldn't care less how we administer the therapy.

It is due to extraneous business issues not directly related to either doctors or nurses, such as hospital billing, payment for services, supply chains, etc.

I see. 

You make me grateful I work in a socialized state system!