Giving a Antibiotic

Guttercat, ASN, RN · Mar 23, 2012

I'm kind of curious as to why this drug is being given in the dialysis setting (assuming since it's an antiviral and non-dialysis related/renal related, it would not be reimburseable to your unit).

Anyhoo, when we have highly dialyzable drugs that must be given after treatment, we will return the blood, and hook up the IV to the dialysis venous access (either CL or AVF/AVG). If you have an AVF/AVG with super high venous pressures or the patient has a SBP > 160's thereabouts...then the infusion may not drip via gravity, obviously. Otherwise, it's no problem.

We move post-dialysis infusion patients to an empty chair or to a separate area to complete the infusion. That way we don't have the dialysis chair jugged up for the next patient and can turn the machine around. With no IV pump, move the patient to an area where you can keep an eye on the rate of infusion.

Joni's Mom · Mar 23, 2012

They say that it will be reimbursed since the nephrologist is ordering it and orders are to go into our computer system???? Don't know the ins or outs and don't really care I guess. Getting tired of the rule changes. The pt has a Diagnosis with CMV and was hospitalized for over a week, was released with 2 doses of this antibiotic left to go. So now it's left on our shoulders to give this.

Pt has a CVA. So I rinse him back. Machine is stopped, venous line still attached, close the saline and attach the IV solution to the venous port of the machine and "hope" the antibiotic drips into the pt? Never had to give an IV post treatment.

By the way this pt does have extremely high B/P

Guttercat, ASN, RN · Mar 23, 2012

They say that it will be reimbursed since the nephrologist is ordering it and orders are to go into our computer system???? Don't know the ins or outs and don't really care I guess. Getting tired of the rule changes. The pt has a Diagnosis with CMV and was hospitalized for over a week was released with 2 doses of this antibiotic left to go. So now it's left on our shoulders to give this.[/quote']
Lol! I get that. :)
But repeat after me "Antiviral!Antiviral!Antiviral!" :) ( Acyclovir is a different animal than an antibiotic).
Anyway, by CVA I assume you mean central venous access or "central line". Remember, a dialysis catheter's end point is the R atrium. So...
...gravity-dripping an infusion via a dialysis central line, regardless of peripheral or vascular resistance pressure, works fine.
If the patient is in your eyesight (because you don't have a pump), and the chair is needed, I myself would be totally comfortable hooking the IV up directly to the central line after the blood has been returned.
Then, once the infusion is done, simply flush and pack the lines as you normally would after any dialysis session.

Joni's Mom · Mar 23, 2012

Correct, antiviral, antiviral, antiviral

Yes central venous access. So what your saying, I think is, forget about the machine totally after rinseback, unhook from the machine, and hook the antiviral IV med to the venous port of the catheter and only use the hook on the machine to hold the antiviral medication, then adjust the drip as if it were a peripheral IV line.

By the way thank you so much for helping.

Guttercat, ASN, RN · Mar 23, 2012

Correct, antiviral, antiviral, antiviral
Yes central venous access. So what your saying, I think is, forget about the machine totally after rinseback, unhook from the machine, and hook the antiviral IV med to the venous port of the catheter and only use the hook on the machine to hold the antiviral medication, then adjust the drip as if it were a peripheral IV line.
By the way thank you so much for helping.

Yes. You got it!

I think it just stinks that your unit does not have a working IV pump, which means you need to keep the infusion and patient in a close line of sight to ensure the drip is not infusing at the wrong rate.

Otherwise, if you think about it as you just did, it's pretty straightforward.

It will also allow you to turn around the machine if you have a patient coming on behind this one.

just keep swimming · Mar 23, 2012

Guttercat is right, that's exactly what I would do. No need to keep that blood circulating outside the body for an extra hour and no need to tie up the chair! And push that FA of yours to get a working IV pump! I guarantee you if she looks hard enough, she will find room in the budget for it. Good luck!