Elm12

Thank you, @nursej22! Very helpful! I am going to print out the chart you linked. I don't have badge access to the computers yet, but I will also see if the EMR has a medication checker, too. That's so nice that the doses came labeled with the infusion rate! Thanks again for your advice!

Thank you, @londonflo, for your thoughtful comment. I really appreciate you taking the time to answer my questions. Your answers are very helpful! 1. Yes, that makes so much sense. I'm going to start looking at the tubing to see how much it takes to prime them and will look at how much, if any, is left in the antibiotic bag. I dislike there being extra medication in the antibiotic bag that the patient doesn't receive! But you're right, knowing the sweet spot of having a full line with all the medicine out of the bag takes practice wisdom, which I hope to cultivate! As an aside, these antibiotics are running as an intermittent primary with 2-3 doses given over 12 hour shift. The extra antibiotic that stays in the line is then given when the next antibiotic is hooked up to the pump, hours later. They run on the primary line with no other fluids. I don't know if this makes sense, but to me, it would seem that if we used a small 50-100 ml bag of NS we could back-prime the antibiotic, then run the antibiotic for the full volume, and then flush the line with NS with the amount that's left in the line. That way they could get the whole dose at once. 2. Thank you for clarifying that it's best practice to not switch secondary lines! The infection prevention aspect makes so much sense! I also found in my drug guide that they do list y-site compatibility for antibiotics, so thanks for pointing me in that direction! At this point, I am only with a preceptor on the floor. He is a good nurse, but has made it abundantly clear that he didn't want a student and is bothered by questions. I did have one instructor in first semester that did follow us into rooms and help us with everything — they were my favorite! However, I was so new at that point I hadn't even thought about the nuances of IV medication administration, so I didn't ask at that time. For the remainder of my clinicals, my instructors assumed that we knew how to do these things at this time and they sat in a room and did other work for the duration of our clinicals. We were pretty much at the mercy of any nice floor nurse who offered to help. Many of my fellow students did get to do externships in the Summer at bigger teaching hospitals and learned a lot! However, I was unable to do that and have little clinical experience compared with them. I also agree that textbook nursing shouldn't be different than real-life nursing! I really enjoy evidence-based practice and always want to embrace it, even if it means updating a method of my nursing practice. I like to understand the why behind doing things, not just because this is how its always been done. Thank you again for your advice and input — it is much appreciated!

Thank you for your input @Been there,done that and for your response! I do agree that these are questions for my instructor and I have asked them to two different instructors and a few nurses on the floor. These have been my responses: 1. I have been told to program the antibiotic short by 10 mls. No one can give me a solid answer if the dose not given is important overall. The reason I'm really asking is because I had a patient ask me about the 10mls he wasn't getting on his 50 ml antibiotic and he mentioned that over 5 doses he was missing a full dose of the antibiotic. 2. I have been told it depends on the antibiotic what to program it at, when I asked how do I know, I was told you'll learn — from where or whom, I am unsure. 3. Our instructors taught us to never use the same line on different antibiotics but I realize textbook nursing is different from real-life nursing. For example, I always ask my preceptor if I need new tubing or if the antibiotics are compatible. She always says no to new tubing and that they are compatible. I asked her how I can find this info out and she said didn't answer me. I graduate in December and I feel frustrated by how much I don't know, the gatekeeping of knowledge by my preceptor, and the lack of clarity from my instructors. I just want to be a safe nurse and not cause patient harm. I guess I'm just overthinking it.

Hi Everyone, I am currently in nursing school and I have a few questions about calculating the VTBI and the pump rate. 1. I often see nurses hang an antibiotic of 50 mls and they program the VTBI for 40 or 45 mls to make sure the line doesn't run dry. I understand that concept but isn't potentially missing 10 ml's of an antibiotic important? Can you not program the VTBI for the whole 50 mls, or is it better to do 40/45 because of it running dry or possibly causing an air embolism? 2. How do you know the ml/hr rate for each antibiotic? Does it tell you somewhere in the chart what to run each specific one at? I have looked in my drug guide and don't see this information. I do know how to calculate a ml/hr rate with this formula: volume (mL) divided by time (min), multiplied by 60 min over 1 hour, but are you given the time to be infused, or is it just assumed it's always over 30 minutes? 3. Can you reuse IV tubing for different antibiotics? I see this all the time and I thought you should only do that if it is the same antibiotic. If you can do this, how do I know the two different antibiotics are compatible because some of the first one is usually still in the line? Thank you for any guidance you can give.