When to piggyback This

Birdy2 · Jan 7, 2015

Well thank you karou. That does help. I was wondering why some nurses do that. I also thought that If I needed to keep the pts fluiss running and give an antibiotic that I was supposed to y it in right below the pump to further dilute the antibiotic, like if it's vanc or something. Another thing I wasn't aware I could do is run two antibiotics at once with no fluids fluids running, like two primary's, one y'd into the other closest to the patient. They were compatible, but I had never heard of giving them at once. It was in the middle of a blood transfusion that was overdue and so were the antibiotics. I gave one unit, the two antibiotics, then hung the other unit. My charge nurse said that was fine. Anyways, thank you all for the help. I do talk to my nurse manager or someone more experienced before doing these things, but then I still question certain things. I'm always looking things up if no one is there to help, but sometimes what u read is different than what people are really doing.

IVRUS, BSN, RN · Jan 8, 2015

Well thank you karou. That does help. I was wondering why some nurses do that. I also thought that If I needed to keep the pts fluiss running and give an antibiotic that I was supposed to y it in right below the pump to further dilute the antibiotic, like if it's vanc or something. Another thing I wasn't aware I could do is run two antibiotics at once with no fluids fluids running, like two primary's, one y'd into the other closest to the patient. They were compatible, but I had never heard of giving them at once. It was in the middle of a blood transfusion that was overdue and so were the antibiotics. I gave one unit, the two antibiotics, then hung the other unit. My charge nurse said that was fine. Anyways, thank you all for the help. I do talk to my nurse manager or someone more experienced before doing these things, but then I still question certain things. I'm always looking things up if no one is there to help, but sometimes what u read is different than what people are really doing.

Here is what I see is the biggest problem with running two IVAB together, though they may be compatible: If your patient has an adverse reaction, how in the world can you assess which antibiotic is the culprit? I've always given them seperately in their own time frame.

OneDuckyRN · Jan 8, 2015

I have seen newer nurses piggyback antibiotics like zosyn (which runs slowly over 3 hours) when the patient has a high rate of Continuous IVF ordered (like 150cc/hr). I always correct them on that because that is three hours that the patient is not receiving the 150cc\hr fluid. It adds up to 450cc missed. So if an antibiotic needs to run for more than an hour, I get a second channel with primary tubing and run it separate, y-site connecting it at the port closest to the patient below the pump. This way the Pt gets the antibiotic and continuous fluid.
That's all I rally have to add.

A little off-topic, I know, but I've never heard of Zosyn being given over 3 hours...what would be the advantage to this? At my facility, Zosyn is always given over 30 min, regardless of dose. The longest antibiotic infusion time I've ever had is Vancomycin over 2 hrs. Just curious!

CountryMomma, ASN, RN · Jan 8, 2015

A little off-topic, I know, but I've never heard of Zosyn being given over 3 hours...what would be the advantage to this? At my facility, Zosyn is always given over 30 min, regardless of dose. The longest antibiotic infusion time I've ever had is Vancomycin over 2 hrs. Just curious!

Zosyn is always given over three hours in my facility, and Vanco never runs for longer than an hour.

In the event I have a high rate IVF running (100mL/hr or more) and something to run secondary (most common is IV abx or mag 2g/4g) I run them under 'concurrent' through the IV pump. This way the pt gets both fluids at their ordered rates. We use Plum Pumps.

Loo17 · Jan 8, 2015

Zosyn is always given over three hours in my facility, and Vanco never runs for longer than an hour.
In the event I have a high rate IVF running (100mL/hr or more) and something to run secondary (most common is IV abx or mag 2g/4g) I run them under 'concurrent' through the IV pump. This way the pt gets both fluids at their ordered rates. We use Plum Pumps.

Where I work the initial Zosyn dose is over 30 min with all over doses being delivered over 4 hours Q8H. The ID docs say that this improves patient outcomes and reduces length of stay by keeping levels constant.

Editorial Team / Admin · Jan 8, 2015

A little off-topic, I know, but I've never heard of Zosyn being given over 3 hours...what would be the advantage to this? At my facility, Zosyn is always given over 30 min, regardless of dose. The longest antibiotic infusion time I've ever had is Vancomycin over 2 hrs. Just curious!

At my facility, it's Zosyn over 4 hours unless being given as a preop antibiotic, where it's run over 30 minutes. I honestly don't know the reasoning behind it.

SierraBravo · Jan 8, 2015

Here is what I see is the biggest problem with running two IVAB together, though they may be compatible: If your patient has an adverse reaction, how in the world can you assess which antibiotic is the culprit? I've always given them seperately in their own time frame.

I agree with this 100%. The only time I would give 2 ABX at the same time is if the patient had been getting them and hasn't had any adverse reactions. That's not to say that the next time I hang the drug they couldn't potentially have a reaction. If it's the first time they are getting these ABX then you should absolutely not run them at the same time, because as IVRUS said, if the patient has a reaction to one of the drugs you won't be able to tell which one they reacted to.

Birdy2 · Jan 8, 2015

Ok. I will think about this next time two antibiotics are due at once. Also, can someone tell me what they see zoledronic acid used for usually? I had to give a 15 min infusion of this followed by 15 min infusion of Pepcid for a pt that had just been diagnosed with metastatic adenocarcinoma (rt lung). I didn't see it on our drug database and pharmacy said these two were actually compatible, but when I went to program them on the pump to run on there own primary's

It gave me a warning not to mix anything with the zoledronic acid. Anyways, I didn't because they were just 15 min each, so I just did one after the other.

We also use Alaris pumps.

sistrmoon, BSN, RN · Jan 8, 2015

A little off-topic, I know, but I've never heard of Zosyn being given over 3 hours...what would be the advantage to this? At my facility, Zosyn is always given over 30 min, regardless of dose. The longest antibiotic infusion time I've ever had is Vancomycin over 2 hrs. Just curious!

Zosyn is given over 4 hours at my hospital unless it's a renal patient, then it's over 30 minutes.

IVRUS, BSN, RN · Jan 9, 2015

Ok. I will think about this next time two antibiotics are due at once. Also, can someone tell me what they see zoledronic acid used for usually? I had to give a 15 min infusion of this followed by 15 min infusion of Pepcid for a pt that had just been diagnosed with metastatic adenocarcinoma (rt lung). I didn't see it on our drug database and pharmacy said these two were actually compatible, but when I went to program them on the pump to run on there own primary's
It gave me a warning not to mix anything with the zoledronic acid. Anyways, I didn't because they were just 15 min each, so I just did one after the other.
We also use Alaris pumps.

One of the main reasons it is given is for high Calcium levels which often are because of CA with bone mets, and it may be given in tx of osteoporosis. I would NOT give this medication with any other drug due to the fact that it is NOT compatible with other medications, and always use a vented tubing set. This medication is under the classification of Antiresorptive medications. This type of med protects the bone and decreases fracture risk.

Birdy2 · Jan 9, 2015

Wow. Of course I didn't run it with anything else just to be safe, but it definitely said that it was compatible with the other med when I looked it up. That's pretty crazy. I'm glad the pump had that warnjng programmed to pop up because I would have given it along with the Pepcid if it hadn't. Next time I question something I'm calling pharmacy and going with what they say.

SierraBravo · Jan 9, 2015

One of the main reasons it is given is for high Calcium levels which often are because of CA with bone mets, and it may be given in tx of osteoporosis. I would NOT give this medication with any other drug due to the fact that it is NOT compatible with other medications, and always use a vented tubing set. This medication is under the classification of Antiresorptive medications. This type of med protects the bone and decreases fracture risk.

Certain resources actually state that Zoledronic acid and Famotidine are compatible at the y-site. But I agree, when you are getting conflicting information (i.e. Pharmacy says yes, but pump says no), it is best to play it cautious especially if they are quick infusions. The reason that people with lung and breast cancer often present with hypercalcemia is because those tumors secrete PTHrP, which results in elevated serum calcium levels.

Birdy, I think you did a great job of investigating and infusing those medications in a safe and proper way. To go a step further, what did you teach the patient about things to watch for regarding the zoledronic acid infusion?