Zithromax IVPB question

dixiebelleRN · Jan 21, 2011

ANY med can be piggybacked with Normal saline, it's the same thing as flushing before or after a drug is given. generally it's not recommended to mix abx with anything else. (excluding some lyte riders) the piggy back setting allows the med to run in and then the fluid to run in once that med is completed.

rita359 · Jan 21, 2011

Just my opinion, but if all those iv fluids are appropriate diluents don't see why you can't piggyback it. There are very few abts we do not piggyback.

shiccy · Jan 21, 2011

ANY med can be piggybacked with Normal saline, it's the same thing as flushing before or after a drug is given. generally it's not recommended to mix abx with anything else. (excluding some lyte riders) the piggy back setting allows the med to run in and then the fluid to run in once that med is completed.

Try running amiodarone with 0.9NS and see what happens

There's two trains of thought, but if you're super freaking out then you could always main line the ATB, "INT" the fluids, and let the ATB run, then resume the IVF afterwards. Almost all meds are 0.9NS compatible, though, and unfortunately the ones that are NOT you have to learn one by one. OUR pharmacy, when the meds are sent up through their mixing process, actually prints directly on the label *** COMPATIBLE WITH D5W ONLY ***, *** DO NOT GIVE WITH OTHER MEDICATIONS ***, or similar. This helps a lot.

Also something that I wasn't aware of, but I guess it makes sense chemically, but SOME medications are stable if running in an IV at a constant rate (aka not sitting for a long time). The short duration of the drug against the "incompatible" solution allows the medication to have its full effect without precipitate. Other medications (such as the amiodarone) will have nice white precipitate right when it smacks into the 0.9NS which not only renders the IV solution useless (it won't have its effect) but will also have a high chance of being rejected by the body. The reaction can be either of anaphylaxis, or can cause a massive DVT from the insertion site all the way up to the major vessels. I've heard of this happening with tube feed (read: NOT TPN/Lipids) given IV, but please note it was NOT at my hospital.

I guess what I'm saying is if you have doubts, contact a pharmacist. OUR pharm has three different sources all with different meds, so they are by far the best resource for compatibility.

rn undisclosed name · Jan 21, 2011

Also something that I wasn't aware of, but I guess it makes sense chemically, but SOME medications are stable if running in an IV at a constant rate (aka not sitting for a long time). The short duration of the drug against the "incompatible" solution allows the medication to have its full effect without precipitate. Other medications (such as the amiodarone) will have nice white precipitate right when it smacks into the 0.9NS which not only renders the IV solution useless (it won't have its effect) but will also have a high chance of being rejected by the body. The reaction can be either of anaphylaxis, or can cause a massive DVT from the insertion site all the way up to the major vessels. I've heard of this happening with tube feed (read: NOT TPN/Lipids) given IV, but please note it was NOT at my hospital.

Well, when you run the amio into a line that was previously flushed with saline some of the amio hits the ns that it was flushed with. Get my drift. So, are you supposed to flush with dextrose and not NS in that case? Just wondering.

shiccy · Jan 22, 2011

Well, when you run the amio into a line that was previously flushed with saline some of the amio hits the ns that it was flushed with. Get my drift. So, are you supposed to flush with dextrose and not NS in that case? Just wondering.

The way I set it up in gtt form is a Y-site w/ a D5W mainline and amio in the Y. If you bleed the lines separately, then Y-connect AFTER they are both primed, then either way your D5W will effectively flush the saline out of the INT. I have also seen D5W flushed in cases of bolusing.

I don't recommend doing it, but if your wasting amio (please note IV route is exceptionally expensive) try it out in a syringe. Just make sure to waste it properly.

MunoRN, RN · Jan 22, 2011

We mix all of our Amio with NS, it does not form a precipitate, and there has never been any evidence to support this. There are however studies that prove the two form a stable mixture.

http://www.ijpc.com/Abstracts/Abstract.cfm?ABS=1285

http://www.ajhp.org/cgi/content/abstract/43/4/917

Precipitates typically form as a result of mixing an acid and a base, which produces a salt. Amiodarone and Normal Saline are both acidic.

The osmolarity of the two is different, which is one reason why when you mix the two you will sometimes see something that looks like white smoke as the mixture homogenizes, but you'll notice the solution turns clear, a precipitate would remain visible.

To get back to the original question, what do you mean by piggybacked? Hung as a secondary or y'd into another line running simultaneously?

jadelpn, LPN, EMT-B · Jul 4, 2013

You are talking about a piggyback, and not concurrent. And pumps have both settings.

Therefore, on a piggybaack setting, your normal saline will stop as soon as you program in and begin the Azithromycin infusion. At the end of the antibiotic infusion, the NS will start up again.

Always follow your facility policy. Some want you to have a dedicated antibiotic infusion. Others want you to piggyback. Regardless, I like that you used the information available to you to try and figure it out! Good call! Another source of info is your pharmacy. They will print out instructions. Also, look at your MD order--does it say IVPB or IV? And always read up on the policy.

eatmysoxRN, ASN, RN · Jul 4, 2013

Just throwing out there that some meds can not be mixed with NS. I gave an med for fungal meningitis (don't recall the name) that had to be run at a certain rate and had to have boluses before and after because of nephrotoxicity. 1/2NS was the maintenence fluid. So you run a D5W bolus, run the abx, run another bolus, then hook regular fluid back up. It was a bit scary.