Infusion times....in a pickle...

[mi_dreamin, BSN]

Strange question here...

I am currently in a 14 week internship for new grads so I'm with a preceptor every shift.

Saturday when I worked I got a little behind and had two IV antibiotics due for one patient at the end of the day, Zosyn to run over four hours and Vancomycin over one hour. It had been a busy shift, a long day, and it was only week four of my first job as an RN (week 3 on the floor).

With that being said, I was a little frazzled and didn't check for compatibility but instead said something to my preceptor about running the Vanc first and then the Zosyn, even though the Zosyn had been due first. She said, "no, I would run the Zosyn first, it can be run in 30 minutes. Just run it at 200." I said "is it okay to do that?" And she indicated that it was.

That didn't really set off alarm bells because someone had just told me that the reason we run Zosyn so slowly is because the longer it is in the body the longer it works but that it can be run faster.

Fast forward to Sunday when I worked and I had a patient that was going to d/c within 1-2 hours but had Zosyn due. I mentioned something in the room in front of the patient/family and my (different) preceptor that the patient had a four-hour antibiotic due but that I could run it as fast as 30 minutes so they could leave (not my exact wording but the gist of what I said). My preceptor said "oh no, we can't do that!"

We didn't say anything else about it until we left the room and I explained why I had said that. She said that running it faster can cause toxicities/renal failure and that you should never run it at 200ml/hr.

I do want to say that I don't believe it is best practice to infuse medication at a rate different than the prescribed rate, and it is not something I plan on making part of my practice. Now that I think about it, outside of the moment, it is a medication error.

However, I researched it some later and from what I can tell, it appears that the manufacturer intended for it to be run over 30 minutes, or 200ml/hr.

So my question is, has anyone ever seen Zosyn (3.8g in 100ml) prescribed to run over 30 minutes?

Also, just out of curiousity, what is everyone's take on what the first preceptor told me - was she way off base or is this something you have done/seen done?

[NurseCard, ADN]

We used to run Zosyn over about 30 minutes all of the time. However,

when I started this job two years ago, I found out that it is now

recommended that it be run over four hours. Like you said, it

is supposed to work better in the body. Anyway, here at my

facility, it is run over 4 hours.

For someone with normal renal function, it is doubtful that you

are going to cause renal failure by running it in over 30 minutes.

[mrsboots87]

Running the initial bolus dose of zosyn is done over 30 minutes. Maintanence zosyn is 4 hours. Both for the reason above, as well as increased incidence of c.diff development when consistently running zosyn over 30 minutes. Once here and there because of a time crunch is likely to not harm a patient. But doing this too many time potentially could.

[mrsboots87]

Also, depending on what the Vanco and zosyn are diluted in (NSor D5) they can be compatible. You may have been able to run them together if you had a strong IV. Next time check your comparability source.

[Okami_CCRN, BSN, RN]

You should follow your hospital's policy regarding medication administration.

With that being said our current policy and practice is to infuse Zosyn over 30 minutes both the 4.5g and 2.25g doses.

[Been there,done that, ASN, RN]

Pharmacy is your friend, consult them. I know the instinct is to just ask your preceptor, but use your other resources.

[JKL33]

If there is any question whatsoever, always speak with the pharmacist.

[cleback]

If a patient is going to dc, are they dc'ing on oral or iv abx? If orals, I may run it by the provider to see if it's really necessary to get in the last run of iv. If on IV, I would consult the pharmacist about timing the infusion with discharge.

[NuGuyNurse2b]

You should follow your hospital's policy regarding medication administration.

With that being said our current policy and practice is to infuse Zosyn over 30 minutes both the 4.5g and 2.25g doses.

In the ER we run it over 30 mins; on the floors, it's 4 hrs. Personally I've run it within minutes. I once connected it to the wrong port, set the pump, came back a few minutes later to see the whole bag emptied and the pump still "running" the Zosyn IVPB. Likewise, I've seen the Zosyn not infusing for the 4 hours because someone forgot to release the clamp to the IVPB tubing so it didn't run, and then the nurse just ran the Zosyn in the calculated ml/hr with the remaining time so as to not interfere with the next dose.

[Ddestiny, BSN, RN]

At my facility, we do the extended length/4 hour Zosyn infusion as part of our pharmacy's renal dosing. Everyone else gets it over 30 minutes. So for us if it's scheduled to infuse over 4 hours, it is so for a reason.

[hawaiicarl, BSN, RN]

30 minutes ... every single time .... can't imagine tying up a line for four hours just for Zosyn.

Cheers

[Daisy4RN]

Like others have stated, in the past it was always run over 30 minutes and that is a fairly new change to run over 4 hrs. Technically if you run it at a different rate than what the MD ordered it is a med error (but it is done all the time). I would also have checked with the MD re: the need for both antibiotics prior to DC and if both needed get an MD order to run the Zosyn faster if possible (explain to MD that the 4hr will hold up pt DC), if MD says no order then run over 4hrs and pt dc when completed (CYA).