Rocephin

NurseStorm, BSN, RN · Jan 20, 2016

A few issues here:

1. You're right, she should not have given 2.5ml in one injection for a 5 year old. Should have been divided.

2. Dorsogluteal is not recommended for use anymore generally as risk to sciatic nerve is quite high. You just wrote glut so I'm assuming that's what you meant, but if you meant ventrogluteal then ignore this.

I am not sure what you mean about the reconstitution. How many mg of Rocephin was in the vial? Its been awhile since I reconstituted. Using lidocaine vs. sterile water or other diluent will not change the amount of mg in the dose. However, if it is for example a 750mg vial, and she reconstituted it and gave the whole vial, then yes she only gave 750mg. If it is a 1000mg vial and she reconstituted it with the lidocaine and gave the whole vial then she gave 1000mg. If she measured out a certain amount and didn't give a whole vial then calculations would have to be done to determine how much she gave. This answer isn't so clear cut... If you have more detail I can try to help more with that aspect.

Lerning4me · Jan 20, 2016

Sorry typing from an Iphone is not the best way. Yes I meant dorsalgluteal not ventrogluteal. I see the confusion so 1000g rocephin once diluted with 2.1 lidocaine to get 350 mg per ml so in this case this child was only given 750 mg and still would need 250 mg more correct!

NurseStorm, BSN, RN · Jan 20, 2016

That's okay! I figured that's what you meant :)

In that case, 2.5ml x 350mg/ml = 875mg. However, I'm having a hard time understanding why if she gave the whole vial and the vial was 1000mg she didn't gave the whole 1000mg ? I'm wondering if you got confused where you read the 350mg/ml and that direction may have been for a different diluent? If she used everything in the vial and the vial was 1000mg the dose should be 1000mg, regardless of reconstitution. Sometimes the doctor may order a way to dilute the med different than what is on the vial and so the reconstitution factor will not match. This is okay if you are giving the full vial in specific special circumstances. But if you are ever giving a smaller dose than the full vial, use great caution that you are calculating correctly. Normally in those situations you would always use the directions on the bottle/hand out for how many ml to add and of what. The doctor may write "may substitute equal amounts of lidocaine for directed amount of sterile water in reconstitution of rocephin".

We rarely give IM meds to kids other than immunizations so this doesn't come up very much for us. We will give it IV if it cannot be given orally. We usually only go for IM if IV tissues and there is only one dose left, or if it is late at night and we can't get IV access they may order one dose IM until morning when the oral rehydration may have made it easier to get an IV.

klone, MSN, RN · Jan 20, 2016

Sorry typing from an Iphone is not the best way. Yes I meant dorsalgluteal not ventrogluteal. I see the confusion so 1000g rocephin once diluted with 2.1 lidocaine to get 350 mg per ml so in this case this child was only given 750 mg and still would need 250 mg more correct!

If the vial says 1000 mg and she gave the entire amount, it doesn't matter how much lidocaine she put in, or how many mls she ended up pulling up into the syringe. If she drew up everything that was in the 1000mg vial, then she gave 1000 mg of Rocephin.

I don't give 1000mg doses too often, but give 250mg doses regularly. The instructions for reconstitution on 250mg is 0.9 ml of diluent, which should make 1ml of reconstituted product, per the instructions. It never does, though. When I mix it together and pull it all up, it still only makes 0.9ml. Why? Dunno. But as long as your pulling out everything that's there in the vial, you are giving the entire dosage that the vial says it is, regardless of how much diluent you use or how many mls gets pulled up in the syringe.