IV ABX by pump...when can I change new bag??

MN-Nurse, ASN, RN · Feb 20, 2012

i have a question regarding iv abx administration via pump. i am a home health nurse and a general rule i know we can't change iv abx times, especially when given once a day. now, i have a pt on iv vanco 1gm in 250ml ns q12hr to infuse over 90 mins via gemstar pump. each iv bag contains two doses (vanco 2gm/520ml ns), with a kvo of 1ml/hr. let's say the pump starts first infusion at 8am and second infusion at 8pm. after second infusion is complete, can the bag be changed any time after 9:30pm and before 8am the following day (as next dose is due)?? or does the bag need to be changed closer to 8am the following day?? i hear co-workers saying that it can be started any time before next dose.
hope my question made sense

ha! found you! boy you like posting this question multiple times....

ick. is that a common infusion order?

i'm really used to one dose per bag piggyback with a ns flush/chaser/kvo bag on the primary.

but that ain't what we got here.

it looks like from your description, the bag can not be changed "any time" after the second dose is given. but it can be changed at almost any time.

lets say you have a nurse who changes the bag at 2130 sharp after the second dose is given. it will run at 1 ml per hour for 10.5 hours until the first dose goes at 0800. then it will run 250ml over 90 minutes. then it will run for another 10.5 hours until 2000 then will try to infuse another 250ml over 90 minutes.

however.....the bag will run out. it will only have 249 ml to infuse on the second dose. (oh no!!)

so, if the nurse replacing the bag waits at least an hour after the second dose is done to replace the bag, you are fine.

oh forget it, just change the frappin' bag whenever you want.

xoNurseRNxo · Feb 20, 2012

Haha! Sorry I realized I posted question in wrong section the first time. Your response makes sense! Thanks.

IVRUS, BSN, RN · Feb 20, 2012

Well, I would personally get your pharmacy to change that KVO rate.

The reason I say this is because you have 3 hours of medication delivery taking up 500 cc total, or 250cc with each dose. Then, 21 hours of KVO at 1cc hour = 21cc total. This is 521 total volume, and you said you only have 520. I would change the KVO rate on the pump to 0.3 or even 0.5cc/hr. 21 x 0.5 = 10.5cc. THIS will give you the ability to change it sooner wiithout worrying about it running dry.

Okay, let's break it down:

Let's say you change the bag at 2300 or 11PM. Total volume = 252.

2300 to 0900= 5 cc gone.

0900 to 10:30 = another 250 gone.

1030 to 2100 = another 5.25 cc gone.

2100 to 2230 = another 250cc gone.

this totals to 510.25cc.

This will give you adequate amount of play time, just in case you need to change it at 0600, for instance.

Does this help?

xoNurseRNxo · Feb 21, 2012

Thank you IVRUS!