I've been in the ED for almost 3 years. We give Rocephin IM on a fairly regular basis. I have always asked for an order for lidocaine to reconstitute it instead of using sterile water. I was told by more experienced nurses when I started that it decreased the pain associated with the injection.
We have a new doc who is very nice but when I asked him for lidocaine, he looked very surprised and asked me why would we ever want to do that. He said that lidocaine stings on its own and he thought it would make it more painful. No biggie, I used sterile water but what I really want to know is have I been incorrectly advocating for my patients all this time by asking for a lidocaine order? I understand that lidocaine stings when injected but my impression has always been that it helps as the drug absorbs into the muscle.
My caveat is that this is an informal inquiry - I have not researched this subject. Just curious.
Our ER we don't need a order to pull out 1% lido to mix with rocephin. We just all do it. But I have heard that it doesn't make that big of a difference for the pt. a shot is a shot. And it stings no matter what
At our facility we also don't obtain an order. But, that's different from not needing an order.
We do all sorts of stuff that requires an order without obtaining one, as do many facilities. Common, but bad practice.
To the OP- I think the key here is "new doc" and "never heard of it". It is common practice, and plenty of places have written protocols. Check your drug guide.
On the side of our vials it specifically gives instructions to reconstitute with 1% Lido or sterile water. Shouldn't need an order to give a medication per manufacturers instructions. I have always given it with Lido unless allergy. The doc that questioned it probably has never been told or needed to be told that nurses have been using Lido with his Rocephin orders all the years he's been practicing.
We just pull 1% Lido as an override med when we give the IM dose of Rocephin...I've never heard anything from pharmacy about it and I'm sure they understand what's going on as they would know the manufacturers recommendation better than most.
Interesting question, I've never thought about asking for an order for the reconstitute...
On the side of our vials it specifically gives instructions to reconstitute with 1% Lido or sterile water. Shouldn't need an order to give a medication per manufacturers instructions. I have always given it with Lido unless allergy. The doc that questioned it probably has never been told or needed to be told that nurses have been using Lido with his Rocephin orders all the years he's been practicing.
We just pull 1% Lido as an override med when we give the IM dose of Rocephin...I've never heard anything from pharmacy about it and I'm sure they understand what's going on as they would know the manufacturers recommendation better than most.
Interesting question, I've never thought about asking for an order for the reconstitute...
When we give 1 gram of Vanc IV, there is no part of the order that says "Reconstitute in 250 NS" yet it always done that way per policy. The policy is that IM Rocephin can be reconstituted in 1-2 mL sterile water or 1-2 mL of 1% lido.
SweetMelissaRN
135 Posts
Ummm... I got mine for strep bc I'm allergic to penicillin but could get rocephin without any problems lol