Rocephin injection question?

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I am feeling really conflicted about a rocephin injection I gave today..another nurse was with me but she just graduated and got her license.

The doctor ordered 850mg of Rocephin. We had on hand 500mg vials and the lidocaine. She pulled two vials down. Ordered to be administered IM * 1

If if you have 850mg ordered how many ml get pulled from each vial or what is the best way to administer 850mg of rocephin when you just have 500mg vials to choose from?

Specializes in NICU, ICU, PICU, Academia. Has 46 years experience.

Is this a homework question?

If not, what did YOU do? Did you consult pharmacy or the package insert? What did THEY indicate?

OldDude

1 Article; 4,787 Posts

Specializes in Pediatrics Retired.

You pull 400 mg from one and 450 mg from the other, or 500 and 350, or 475 and 375...it doesn't matter as long as 850 mg are administered.

Meriwhen, ASN, BSN, MSN, RN

4 Articles; 7,907 Posts

Specializes in Psych ICU, addictions.
You pull 400 mg from one and 450 mg from the other, or 500 and 350, or 475 and 375...it doesn't matter as long as 850 mg is administered.

This. As long as the patient gets 850mg in them, that's all that's matters.

My preference: I'd rather have one partially-used vial lying around as opposed to two of them, so I would have gone with 500 and 350.

OldDude

1 Article; 4,787 Posts

Specializes in Pediatrics Retired.
This. As long as the patient gets 850mg in them, that's all that's matters.

My preference: I'd rather have one partially-used vial lying around as opposed to two of them, so I would have gone with 500 and 350.

Me too

Ladyscrubs

144 Posts

Specializes in Nursey stuff. Has 36+ years experience.

Not just the mg's but also remember the ml's. For adults: 2 ml in the deltoid and thigh muscles, and up to 5 ml in the gluteus maximus. (Hint), Rocephen should be injected into a relatively large muscle. I am trying to remember the reconstitution, Hmm... I think, but don't quote me, that you might be injecting approx 4.6 ml's. Read your vials.

Specializes in Psychiatric and emergency nursing. Has 10 years experience.
Not just the mg's but also remember the ml's. For adults: 2 ml in the deltoid and thigh muscles, and up to 5 ml in the gluteus maximus. (Hint), Rocephen should be injected into a relatively large muscle. I am trying to remember the reconstitution, Hmm... I think, but don't quote me, that you might be injecting approx 4.6 ml's. Read your vials.

I agree that the ml pulled from each vial is neither here nor there, but it does make sense to pull all 500mg from one vial, and 350mg from a second. However, if your question is regarding injection sites, they are as follows:

Deltoid: max 1ml

Vastus lateralis (thigh) and dorsogluteal (gluteus maximus): 4ml max (however, in the glutes, you run the risk of compressing the sciatic nerve if you attempt to inject the maximum and are too near the nerve)

Ventrogluteal (hip): No maximum

Also, FWIW, I never inject Rocephin into the deltoid. Oh the soreness...

Julius Seizure

1 Article; 2,282 Posts

Specializes in Pediatric Critical Care.

OP, What did you feel conflicted about?

humerusRN

100 Posts

Has 7 years experience.

It's been awhile since I have had to do Rocephin (ya'll, I hate IM shots they are my kryptonite, I have no idea why) - but I do know that in small babes we often have to give two injections vs. 1 to accommodate the dosing. When this happens we go with two RNs and each take a leg. Oh I feel nauseous thinking about it. LOL....

Amethya

1,821 Posts

Specializes in Cardiology, School Nursing, General. Has 5 years experience.
It's been awhile since I have had to do Rocephin (ya'll, I hate IM shots they are my kryptonite, I have no idea why) - but I do know that in small babes we often have to give two injections vs. 1 to accommodate the dosing. When this happens we go with two RNs and each take a leg. Oh I feel nauseous thinking about it. LOL....

And even with Lidocaine that stuff hurts!

Specializes in Peds ED. Has 12 years experience.

I've never seen multi-use bottles anyway, so the excess is waste regardless. I think I always empty my first vial because if I take 50% of the dose from each that's one more calculation that isn't necessary when you're visually just getting to whatever the calculated ml are.

Specializes in Peds ED. Has 12 years experience.

Adding that for pediatrics you need to internalize the DOSE ORDERED / AMOUNT ON HAND x QUANTITY formula. So for children's Tylenol, if you need to give 250mg, that would be 250mg / 160mg * 5ml = 7.8 ml.