push or infuse antibiotics to the febrile neutropenic patient

[blue444]

Hi all, i am currently working on a paediatric oncology unit in western australia. I am doing post graduate studies which requires me to do a research project.

I chose to look at the method of administration of medications, especially antimicrobials, to the febrile neutropenic patient via a central line.

On my ward we mostly infuse antibiotics over 15-30mins on a pump, however we do occasionally give them via a direct bolus or 'push' over 3-5minutes depending on the nurse giving the medication and the recommended administration time found in the 'injectable medications book'. My question for you is... how do YOU do it? and why? push or infuse? what is your hospital/ward policy? which hospital do you work at?

does infusing medications decrease the incidence of catheter related blood stream infection?

I am hoping to prove that pushing medications does not increase infection rates, ultimately eliminating the need for an IV and pole, leading to more freedom for children whilst in hospital.

thanks for your help:wink2:

[canoehead, BSN, RN]

I think pushing vrs infusing has more to do with phlebitis, and adverse reactions than infection rates. For example gentamycin pushed will cause hearing loss.

[blue444]

thanks, medications are only pushed according to manufacturers instructions. I am refering only to IV medications which are safe/recommended as a push.

[iluvivt, BSN, RN]

Of course,you must follow the manufactures and hospitals recommendations for rate of administration. With that said I do not see a big connection between choosing to push an antibiotic vs administering as a piggyback would have a dramatic effect on CRBSI. Catheter-related bloodstream infections have been extensively studied and their causes are understood,even though their is on-going research,especially with biofilm. Most come from the skin at the catheter skin junction and from the IV system (usually caps,hubs and injection ports). Actually,by constantly entering the system with push meds would increase your rate...not decrease your rate. It would be actually better to hang a med bag and hang as secondaries or via syringe pump or retrograde. I think a better topic would be what can we do to decrease CRBSI in this population. You can explore the true causes and stategies to decrease the rate. For example, use of maximal barrier precautions during insertion,strict dressing change procedure,proper cap care,and daily check for need of the line.

[blondy2061h, MSN, RN]

I've never pushed an abx. Giving it over 15-30 minutes should be fast enough.

[blondy2061h, MSN, RN]

I lied. I just remembered we push Meropenem sometimes.

[accessqueen]

Each medication has instructions from the manufacturer on how to administer. Some drugs, (rocephin) can be pushed. Some drugs (vanco) absolutely cannot be pushed, even infusing too fast can cause severe problems. Another reason to not push, is that anyone can develop an allergy to a med at any time, even if its' something they have been getting for a long time. Once you've pushed something, it's in, done deal, no way to get it out. If the patient develops a reaction, big trouble. If you're infusing, and something develops, you can stop the infusion. I think it's dangerous to pursue an increase in pushing drugs, too many things are already pushed too fast (phenergan, lasix, morphine, etc.) with the potential to cause problems. Bottom line, you have to follow manufacturers guidelines, if you don't and something goes wrong, it's your butt.