Intraoperative Antibiotics

[DrOwnage]

Transitioning from Intern year to anesthesia I've noticed that in the OR we give large doses of antibiotics reconstituted in very small volumes (~10mL-50mL), which are then pushed intravenously. Does everyone use this practice? It seems a little weird to me and maybe dangerous to expose the patient to that concentration. Does this also increase the chance of possible drug reactions?

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[waterbottle10]

Transitioning from Intern year to anesthesia I've noticed that in the OR we give large doses of antibiotics reconstituted in very small volumes (~10mL-50mL), which are then pushed intravenously. Does everyone use this practice? It seems a little weird to me and maybe dangerous to expose the patient to that concentration. Does this also increase the chance of possible drug reactions?

Yep. I don't push vanc or gentamicin. Most others i push unless it's in a bag then I infuse. I actually read the bottle of cefazolin 1g today. It says reconstitute in 3ml of sterile water.. Surely they aren't expecting you to infuse 3ml... I just mix in a 20ml syringe and push.

 

[fakin' the funk]

Transitioning from Intern year to anesthesia I've noticed that in the OR we give large doses of antibiotics reconstituted in very small volumes (~10mL-50mL), which are then pushed intravenously. Does everyone use this practice? It seems a little weird to me and maybe dangerous to expose the patient to that concentration. Does this also increase the chance of possible drug reactions?

A) why would the concentration of the infusion, as opposed to the infusion rate, matter
B) not if it's not vanco or maybe something exotic like gent

 

[deleted162650]

Clinda is the other one you shouldn't bolus in addition to Vanc and gent. Everything else can be rifled in no problem. Time to stop thinking like a pansy internist

Wait till you see how fast we give blood.

 

[sethco]

Clonda is the other one you shouldn't bolus in addition to Vanc and gent. Everything else can be rifled in no problem. Time to stop thinking like a pansy internist

Wait till you see how fast we give blood.

Why can't you bolus Clindamycin?

 

[anbuitachi]

Clonda is the other one you shouldn't bolus in addition to Vanc and gent. Everything else can be rifled in no problem. Time to stop thinking like a pansy internist

Wait till you see how fast we give blood.

or nurses haha. not long ago i had a patient in the ICU whos pressure was tanking on the Arterial line (patient just got resuscitated from arrest a few minutes ago). i asked the nurse to bolus x amt of norepi. she told me, no we dont do bolus here, only infusions. so i had to wait for her to set up the pump and everything. good thing he didn't code again

 

[deleted162650]

Why can't you bolus Clindamycin?

Case reports of cardiac arrest following bolus of IV Clinda including one high profile case a major military hospital. Please don't ask me the mechanism.

 

[dhb]

Case reports of cardiac arrest following bolus of IV Clinda including one high profile case a major military hospital. Please don't ask me the mechanism.

What's the mechanism?

 

[Arch Guillotti]

i asked the nurse to bolus x amt of norepi. she told me, no we dont do bolus here, only infusions. so i had to wait for her to set up the pump and everything. good thing he didn't code again

Why didn't you dilute it yourself and bolus it?

 

[IlDestriero]

or nurses haha. not long ago i had a patient in the ICU whos pressure was tanking on the Arterial line (patient just got resuscitated from arrest a few minutes ago). i asked the nurse to bolus x amt of norepi. she told me, no we dont do bolus here, only infusions. so i had to wait for her to set up the pump and everything. good thing he didn't code again

You can always draw it off their bag, dilute as appropriate and give it yourself. They have their nursing protocols and we do what we want.


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Il Destriero

 

[pgg]

You can always draw it off their bag, dilute as appropriate and give it yourself. They have their nursing protocols and we do what we want.

LOL, a smile and "I do what I want" is what I respond with every time an ICU nurse or RT tells me I can't do something with their pumps or ventilators.

 

[pgg]

Transitioning from Intern year to anesthesia I've noticed that in the OR we give large doses of antibiotics reconstituted in very small volumes (~10mL-50mL), which are then pushed intravenously. Does everyone use this practice? It seems a little weird to me and maybe dangerous to expose the patient to that concentration. Does this also increase the chance of possible drug reactions?

I occasionally have trouble getting 2 g of cefazolin to dissolve in a 10 mL syringe. But the 20 mL syringes come in these stupid plastic packs you have to carefully peel open, and that takes time. Sometimes I imagine the RBCs in the right atrium screaming at the osmotic difference when I slam it in through the central line.

 

[IlDestriero]

LOL, a smile and "I do what I want" is what I respond with every time an ICU nurse or RT tells me I can't do something with their pumps or ventilators.

I'm a little more diplomatic.
It is important to remember that nursing protocols and guidelines don't govern our practice, especially in emergencies. And, "I don't know if you can do that" isn't your concern either.


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Il Destriero

 

[pgg]

I'm a little more diplomatic.
It is important to remember that nursing protocols and guidelines don't govern our practice, especially in emergencies. And, "I don't know if you can do that" isn't your concern either.

Oh, I say it with a smile. I'm only 1/17th the smartass in real life as I am on the internet.

 

[deleted697535]

You haven't lived til you've bolused vanc!!

I think rt is the scariest part of moving to North America. How does one not punch them? I had one attempt to lecture me on ventilation one night at 3 am despite her controlled mode in a non sedated trache pt causing obvious breath stacking and subsequent arrest by 6 over 3 nights. It was scary! She didn't even know what simv was but was still convinced she was 100% right. Even rolling her eyes at me

 

[IlDestriero]

They don't have to understand the vent modes, they just have to execute your plan. Thank them for their concerns and ask where the SIMV mode is if they won't do it. I had a run in with a ***** RT that ended with me bagging the patient off the vent, ordering the RT away and having the nurse call the other unit for the other RT. That was frightening and eye opening. She also got the vec that I used to carry around next to the stick of neo. They have one job... the fancy box with the tubes on it...


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Il Destriero

 

[drmwvr]

I consider it far less than when I push an amp of bicarb or D50 and I don't consider it much those times.

 

[anbuitachi]

We had a patient die once in the ED cause the RT switched the vent modes w/o telling any doc. I dont remember what mode it was but basically died of hypercapnia

Why didn't you dilute it yourself and bolus it?

Cause in NY the nurses are the boss. you dont do it if they tell you not to.