When to piggyback This

[Birdy2]

Ok so Ive noticed a lot of nurses to this differently and I'm just trying to figure out a rule to go by. I never know when I should piggyback something with iv fluids or y it in under the pump to run with fluids. I know some things are better diluted and running with fluids, but I'm also confused about how that works. If u y an antibiotic into the port below the pump with ns running at say 75, then won't the antibiotic be going in at that rate instead of say 12.5/hr? I don't get how it could run at its kwn rate unless it's piggybacked. this may sound like a stupid question but I never really fully understood how this works, especially since we had so very little practice with IV pumps in school. So anyways, can someone explain this and how I know when to do what. I use a drug book, but often times I don't even understand the administration instructions and there isn't always someone there to ask.

[VANurse2010]

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.

I've seen meropenem run over 3 hours in specific circumstances, but it, like Zosyn, is typically run over 30 minutes (I've never seen Zosyn ordered for anything but 30 minutes). Vancomycin can be run over an hour, but most commonly, depending on dose, I've seen it run over 90 minutes or 2 hours.

Just goes to show how facilities can differ.

[Birdy2]

Well I told them about signs of hypocalcemia and also that it could cause bone pain, nausea, and fatigue. These are the things that I found to be the most common side effects when I looked it up. Is there something else that I missed? Like I said, I had never given this med or even heard of it, but I'm sure working on an oncology floor would help u to be more familiar with the common adverse effects and what not

[SierraBravo]

Well I told them about signs of hypocalcemia and also that it could cause bone pain, nausea, and fatigue. These are the things that I found to be the most common side effects when I looked it up. Is there something else that I missed? Like I said, I had never given this med or even heard of it, but I'm sure working on an oncology floor would help u to be more familiar with the common adverse effects and what not

Perfect! If there is one thing that I have learned in my NP program thus far is that when teaching patients about adverse effects of medications, only give them the top 3 or 4 that are most important. The patient is probably not going to hear anything you say after you list the 3rd or 4th adverse effect.

[PacoUSA, BSN, RN]

My former hospital switched to running Zosyn over 4 hours for everyone, the rationale being that it is more effective delivered at a slower rate and that it is easier on the kidneys (I'm just reporting what they said, I don't have evidence based data on this). At my present hospital however, Zosyn is run over 30 min for everyone so I don't get the difference among institutional uses if patients come in with similar conditions.

[wheeliesurfer]

From personal experience I prefer Vanco to be delivered over at least two hours if infusing into a PIV instead of a central line because it is so harsh on the veins. If a patient has Vanco running through PIV and is complaining of pain ask the consulting MD if you can infuse over a longer period of time. Also check the site frequently to insure it is still patent. I had mine infiltrate and ended up with soft tissue damage.

Also, I've usually seen Zosyn dosed over four hours unless it is a pre op or renal pt.

[CountryMomma, ASN, RN]

From personal experience I prefer Vanco to be delivered over at least two hours if infusing into a PIV instead of a central line because it is so harsh on the veins. If a patient has Vanco running through PIV and is complaining of pain ask the consulting MD if you can infuse over a longer period of time. Also check the site frequently to insure it is still patent. I had mine infiltrate and ended up with soft tissue damage.

Also, I've usually seen Zosyn dosed over four hours unless it is a pre op or renal pt.

There's the rub in my opinion - I'm on a floor where a good majority of my patients are in or have renal failure. That's why my run times on so many meds are different. We don't use Vanco on our floor very often, honestly. It just kills weak kidneys.