IVPB 5-6hrs of ABX when pt is on cont IVFs

[fiveofpeep]

I have a question. I've always known to be cognizant of the rate of IVPB so that your patient will still get the fluid volume prescribed when you are giving an IVPB, but what about this:

You have a patient with a normal maintenance IV fluids of D5 or of NS + KCL going at some prescribed rate, and you have about 5 consecutive hours of prescribed IVPBs. What should you do? Should you run each IVPB on it's own line (not piggy back it) so the D5 isnt interrupted in an NPO patient receiving insulin? Or what about interrupting KCL for that long? Will it make that much of a difference? What about if the patient is fluid overloaded?

I have heard differing opinions regarding this. What do you all think? Im going to ask our intensivist too but I wanted to see what you ICU gurus think.

[kvsherry]

i have a question. i've always known to be cognizant of the rate of ivpb so that your patient will still get the fluid volume prescribed when you are giving an ivpb, but what about this:

this has come up in my unit before, it's a great question.

you have a patient with a normal maintenance iv fluids of d5 or of ns + kcl going at some prescribed rate, and you have about 5 consecutive hours of prescribed ivpbs. what should you do? should you run each ivpb on it's own line (not piggy back it) so the d5 isnt interrupted in an npo patient receiving insulin? or what about interrupting kcl for that long?

that's exactly what you do. run a ns at 10ml/hr kvo and hang your abx through that. your insulin patient will need that dextrose, and if you interrupt the kcl, then you will constantly be playing catch up chasing your k, causing you to have to hang more piggy backs further interrupting your miv etc, etc.

will it make that much of a difference?

it makes a huge difference.

what about if the patient is fluid overloaded?

if your patient is fluid overloaded, and they have a central line, transduce a cvp. in facilities that i have worked for, this was a nursing call that did not need an order. also, if your patient is really on fluid restriction and you are that worried that they will be getting too much, bring your concern up with the doc. the 10ml/hr won't make much difference, were only talking 240ml/day. however, your abx/piggy backs can add up.

i have heard differing opinions regarding this. what do you all think? im going to ask our intensivist too but i wanted to see what you icu gurus think.

i might suggest bringing this up with your cns/unit educator instead of the intensivist. unless you have a really good relationship with them.

i hope this helps!

[detroitdano]

Unless your patient has an EF of 10% or they're not making urine, you're not going to to have to worry about overloading them with a maintenance line and a KVO line for piggybacks.

A better solution if you're worried about intake is to call pharmacy and have them concentrate down antibiotics. Sometimes we get antibiotics that are mixed with 500 mL and if it's doable they can make it a 100 mL bag instead.

If I have someone in that situation with a maintenance solution and lots of piggybacks, or foreseeable piggybacks (lytes replacements for example), I always start a KVO line.

[tri-rn]

If someone is truly fluid overloaded then they shouldn't be getting much maintenance fluids.

[sunnycalifRN]

If someone is truly fluid overloaded then they shouldn't be getting much maintenance fluids.

That's right! You should KVO the maintenance fluid and then tell the doc that's what you did.

For a pt who can tolerate the fluids, I just run the abx on a separate line or "Y" in the abx with the IV fluid.

[Nurseboy1]

Why not see if some of the antibiotics could be given PO or via tube? Would definitely cut down on the fluids and maintenance interruptions

[fiveofpeep]

Why not see if some of the antibiotics could be given PO or via tube? Would definitely cut down on the fluids and maintenance interruptions

no NGT for the pt and the infection is very very severe but Ill definitely try suggesting that if it comes up with a different patient

[fiveofpeep]

Well the last two nights I followed your advice. I only ran one IVPB (one that goes over 15 minutes) and hung the other 6 hours of ABX on their own line while the maintenance was still going. She was a little hypotensive tonight so it worked out well I think.

Thanks everyone!

[TulsaTime]

Another option if your pumps will do it is to run your IVPB concurrent. We have the plum pumps & we can run 2 lines (the primary & piggyback) concurrently so you don't have to add another fluid, more pumps, etc to the mix.

[fiveofpeep]

Another option if your pumps will do it is to run your IVPB concurrent. We have the plum pumps & we can run 2 lines (the primary & piggyback) concurrently so you don't have to add another fluid, more pumps, etc to the mix.

our pumps dont do this. I wish they did!

[NotReady4PrimeTime, RN]

I work in a pediatric ICU where most of our patients are fluid-restricted. We run our abx at the maximum central concentration to minimize the amount of fluid they get from that source and they run on a syringe pump for the most part. We also will calculate the total volume they'll receive from their IV meds and subtract that from their daily total fluid intake, then divide up what's left by 24 for their maintenance IVF. For our neonates, their TFI might be less than 240 mL in a day, so we've got to be very careful.