Silly to have this clarified?

[Lahryn04]

Hey guys! So I just recently hung a protonix drip on a pt with a GI bleed. The order from the ER doc read like this "protonix IV 8mg/hr" that's all. Pharmacy sent me up 4 vials of protonix with 40mg in each. The instructions they sent with it told me to take a bag of 100ml NS, draw out 20cc of NS and reconstitute each protonix bottle with 10ml (only 2 vials were to be used) and inject them back into the bag. So that left me wondering why they sent 2 more vials... Called pharmacist to clarify and she said I was to push 80mg first then start the drip. This did make sense to me but I had never done one of these so I asked 4 other coworkers who had... The first 3 had never pushed the 80 prior to the drip. The last one had but stated the docs order said to that. Called the pharmacist back who told me it's policy to do that, I asked her to write a clarification for me and she put up this attitude. After telling her I refused to push the bolus until I had a clarification she eventually did write one... But not before making me feel like an absolute idiot.... What are your thoughts on this...

[caliotter3]

I agree that it should have been written on the order. Having not administered this drug IV before, I would have had no idea how to go about it without making that call to clarify like you did. And it certainly is interesting that some of the people you asked had never done the push. Not a widely known or followed policy, eh?

[nola1202]

Good for you for picking up the phone and calling. Good for you for sticking to your guns and making sure the order was clarified. Pushing anything IV without an explicit order is a good way to get thrown under the bus if something goes wrong. (allergies, some strange reaction, an MD who says, I didn't want it given that way...) The policy in pharmacy may read that way but obviously, it isn't well known on the unit.

[RhondaIndyRN]

Yes, in my opinion you did the right thing...safe patient care and cya!

Rhonda

[Art_Vandelay]

Hey guys! So I just recently hung a protonix drip on a pt with a GI bleed. The order from the ER doc read like this "protonix IV 8mg/hr" that's all. ...

Just to clarify, you meant Protonix 80mg/hr. :)

I would have acted in the same manner. There was no order for 80mg bolus, then 80mg/hr drip...and if 3/4 nurses had never done it before and 1 had an explicit order, how is it a well know policy?

[Lahryn04]

Just to clarify, you meant Protonix 80mg/hr. :)

I would have acted in the same manner. There was no order for 80mg bolus, then 80mg/hr drip...and if 3/4 nurses had never done it before and 1 had an explicit order, how is it a well know policy?

Thanks for the reply and validation on my request but no I actually do mean 8mg/hr, 10ml/hr... This if standard for a continus infusion from what I've read. Although I'm sure there are other situations in which 80mg/hr would be appropriate.

[Art_Vandelay]

I stand corrected. :) Thanks!

[K+MgSO4, BSN]

So I Googled the trade name protonix..........it is pantoprazole, a proton pump inhibitor. for a GI bleed yes you would bolus 80 mg and then start on 8mg/hr or 10ml/hr. However I would of been asking the doc for a separate order for the bolus rather than the pharmacy for clarification. but it is standard practice for upper GI bleeds.

You can push pantoprazole but you cannot push omprazole.

[CourtCav25]

Oh that makes a lot more sense. I was slightly confused why they would want 8mg/hr and an 80mg bolus to start off! Lol, see: clarification is always a good thing!! :)

[solneeshka, BSN, RN]

The pharmacist shouldn't have gotten ***** with you, but if it were me, I would have gone to the MD. I don't care what the pharmacy policy is, I'm not giving any drug the doctor hasn't ordered! And a bolus was clearly not ordered, regardless of whether or not it should have been. But good job sticking to your guns.

[#1ME]

To mix a protonix drip at my hospital (done plenty since I work night shift and pharmacy is closed), we mix 5 vials of protonix 40 mg vials, which yeilds a total of 200 mg. We then mix that into a 250cc bas of normal saline, the set the rate at 10cc/hr, which is a dose administration of 8 mg/hr

[StayLost, BSN, RN]

Just to clarify, you meant Protonix 80mg/hr. :)

I would have acted in the same manner. There was no order for 80mg bolus, then 80mg/hr drip...and if 3/4 nurses had never done it before and 1 had an explicit order, how is it a well know policy?

Um, let me just clarify , Protonix is infused at 8mg/hr -- that is standard dosage! It doesnt matter how big or small the pt is, 8mg/hr is is the "staple" or "standard" dose of Protonix for GI bleeds.