Southern Trust Home IV Service Guidelines for the administration of IV antibiotics Title: Author: CLINICAL GUIDELINES ID TAG Antibiotic guidelines - Southern Trust Home IV service guidelines for the administration of IV antibiotics Mrs A McCorry/ Mrs P Curran Speciality / Division: Directorate: Date Uploaded: Review Date Clinical Guideline ID Pharmacy,, IV/SC Therapy Co-ordinator OPPC February 2019 CG0487
DOCUMENT CONTROL Version 3 Authors Ann McCorry, Antimicrobial Pharmacist, Pharmacy Department Craigavon Area Hospital Ext: 3839. Revision Date February 2019 Pauline Curran, IV/SC Therapy Co-ordinator, OPPC. Mob: 07917391012
Contents 1. NMC standards for administration 2. Drug information and monitoring 3. Drug reconstitution and administration information
NMC STANDARDS FOR Adhere to the NMC Standards for Medicines Management. RCN calculation formulae (RCN Standards for Infusion 2007): Drug Calculation What you want x stock What you ve got Gravity flow Volume in ml x Drops in ml Hours of infusion 60 All intravenous medicines administered should be given independently of each other. To avoid potential drug-drug interactions, no mixing of drugs should occur, including piggybacking on the same intravenous line. Reconstituted solutions should be administered immediately after preparation. They are for single use only and any remaining solution should be disposed of appropriately-refer to individual product literature. Midline catheters offer an alternative to peripheral and central venous access, providing vascular access in a larger peripheral vein without entering central venous circulation. If used for the administration of home IV therapies, please note the following are contra-indicated for administration via a midline catheter: Vesicant medications Total Parenteral Nutrition (TPN) Solutions, medications with ph <5 or >9, and those with osmolarity >600mOsm/l. IV anti-infectives are a critical medicine, where the timeliness of administration is crucial. While all medicines should be administered in a timely manner, every effort must be made to avoid delayed and omitted doses of critical medicines. o An omitted dose is a dose that has not been administered before the next dose is due. o A delayed dose is a dose that is administered more than two hours after the prescribed time and before the next dose is due. IV anti-infectives are a critical medicine, where the timeliness of administration is crucial. While all medicines should be administered in a timely manner, every effort must be made to avoid delayed and omitted doses of critical medicines. o An omitted dose is a dose that has not been administered before the next dose is due. o A delayed dose is a dose that is administered more than two hours after the prescribed time and before the next dose is due. If the patient does not receive a prescribed medicine, for whatever reason, this must be clearly documented on the administration record and this should be highlighted to the relevant medical staff. A comprehensive record of such omissions and the action taken must be made in the patient s nursing notes. An IR1 form via Datix Web must also be completed if the omission or delay was unintentional. All patients must recieve first dose of IV antibiotic therapy within a clinical setting. Alternatively a General Practitioner/ Home IV Co-ordinator can administer the first dose of IV antibiotric therapy within the community setting.
DRUG INFORMATION AND MONITORING For full drug information, refer to the most up to date version of the SPC or BNF which will include dosing schedules, interactions, side-effects etc. Side effects of antibiotics are common, including diarrhoea. However, the appearance of marked diarrhea (including bloody diarrhea) should be regarded as an indication that the medicine should be discontinued immediately and reported to the named Consultant. If concerned about any side effect contact the Home IV Co-ordinator or named Consultant on discharge for advice. Hypersensitivity reactions can occur at any time during the treatment course. If this develops, withhold further treatment until medical advice obtained. Patients should be monitored as instructed on discharge, which may include full blood counts, urea and electrolyte profile, liver function tests and CRP and additional drug specific monitoring as advised. If the patient is not improving or deteriorating on the prescribed treatment, contact the Home IV Co-ordinator or named Consultant on discharge for advice. During weekends or out of hours if medical advice id required the district sister can contact the discharging ward, the named Consultant on discharge or their team. If the venous access fails and the district nurse is unable to re-cannulate, the patient should return to the ward for re-cannulation during home IV treatment. The local medicines information department (Craigavon Area Hospital Ext. 2976) and wards that have clinical pharmacy services will provide further information on the drug(s) if required.
DRUG RECONSTITUTION AND INFORMATION DRUG NAME RECONSTITUTE WITH PREFERRED ROUTE SUITABILITY FOR MIDLINE DILUTION FOR INFUSION IF REQUIRED DETAILS AMOXICILLIN Each 250mg vial with 5mls water Doses up to 1g IV Bolus No N/A IV Bolus over Each 500mg vial with 10mls water Doses >1g Yes Dilute with 100ml Each 1g vial with 20mls injection AZTREONAM Each 1g or 2g vial with 10mls water IV Bolus No N/A IV Bolus over No 1g: Dilute with 50ml 2g: Dilute with 100ml CEFAZOLIN (note: unlicensed in UK, to be prescribed on microbiology recommendation only) Each 1g with 4mls Up to 1g as IV Bolus >1g as IV Infusion No N/A IV Bolus over No Dilute with 50mls CEFOTAXIME Each 500mg vial with 2mls water Each 1g vial with 4mls injection Each 2g vial with 10mls IV Bolus Yes May be diluted with for administration as per prescribing Hospital Authorisation Yes Dilute with 100mls NaCl 0.9% IV Bolus over CEFTAZIDIME Each 500mg vial with 5mls water Each 1g vial with 10mls injection Each 2g vial with 10mls Branded products: Refer to monograph for reconstitution IV Bolus Yes N/A IV Bolus over Yes Dilute with 100ml Pre and post NaCl flushes required: Cannula: 5mls, Midline/PICC line/portacath: 10mls
DRUG NAME RECONSTITUTE WITH PREFERRED ROUTE SUITABILITY FOR MIDLINE DILUTION FOR INFUSION IF REQUIRED DETAILS CEFTRIAXONE Each 1g with 10mls water for Up to 1g as IV Bolus Yes N/A IV Bolus over Each 2g with 40ml 2g as IV Infusion Yes Infuse directly from vial at least 30 minutes CLINDAMYCIN N/A Yes Dilute with : 300mg & 600mg: 50ml 900mg: 50-100ml 1200mg: 100ml The concentration should not exceed 18mg in 1ml 300mg over 10 minutes 600mg-900mg over 1.2g over 40-60 minutes CO-AMOXICLAV Each 600mgs with 10mls Each 1.2g with 20mls water for IV Bolus No N/A IV Bolus over No Each 600mg with 50mls COLISTIN (COLOMYCIN) Each 2 million units dissolved in 10mls water for. Up to 2 million units as IV Bolus (only if via a totally implanted venous access device) Yes N/A IV Bolus over 5 minutes >2 million units as Yes Dilute with 50mls NaCl 0.9% or Glucose 5% DAPTOMYCIN Each 350mgs with 7ml Each 500mgs with 10ml Gently rotate and allow to dissolve for 10-15 minutes IV Bolus No N/A IV Bolus Over 2 minutes No Dilute with 50mls NaCl ERTAPENEM 1g vial with 10mls water for or sodium chloride 0.9%. Yes Dilute with 50mls NaCl Pre and post NaCl flushes required: Cannula: 5mls, Midline/PICC line/portacath: 10mls
DRUG NAME RECONSTITUTE WITH PREFERRED ROUTE SUITABILITY FOR MIDLINE DILUTION FOR INFUSION IF REQUIRED DETAILS GENTAMCIN (ONCE DAILY) Only suitable for home administration if no levels are required N/A No Dilute with 100mls MEROPENEM Each 500mgs with 10mls. Allow solution to become clear before using IV Bolus (500mg-1g) (>1g) Yes N/A IV Bolus over 5 minutes Yes Dilute with 100ml 15- METRONIDAZOLE N/A Ready to use bags: Yes N/A 20 minutes (5ml/min) PIPERACILLIN / TAZOBACTAM (TAZOCIN) Each 2.25g vial with 10mls IV bolus (unlicensed) Yes-only if further diluted For use in midline: Add reconstituted solution to 50mls IV bolus over 5 minutes as per Trust policy Each 4.5g vial with 20mls Yes Dilute with minimum of 50mls Reconstitute as per manufacturer s instructions TEICOPLANIN Make up slowly with the entire contents of the diluent ampoule ( ) provided. Roll gently. Do not shake. Leave to stand for 15 minutes to allow foam to settle before use. IV Bolus Yes May be diluted with. for administration: Up to 10mls if <1g Up to 20mls if 1g Yes Dilute with 100mls IV Bolus over 800mg over 30 minutes >800mg over 60 minutes TIGECYCLINE Each 50mg with 5.3ml NaCl 0.9%. Yes Dilute with 100mls Reconstitute as per manufacturer s instructions Pre and post NaCl flushes required: Cannula: 5mls, Midline/PICC line/portacath: 10mls
DRUG NAME RECONSTITUTE WITH PREFERRED ROUTE SUITABILITY FOR MIDLINE DILUTION FOR INFUSION IF REQUIRED DETAILS TOBRAMYCIN (refer to monitoring protocol) Adhere to prescription & administration authorisation as per Regional Respiratory Unit, Belfast City Hospital. N/A IV Bolus No May be diluted for administration as per Regional Respiratory Unit, Belfast City Hospital. Hospira brand: Yes when diluted to 13.33mg/ml with. Dilute with 50-100mls IV Bolus Intravenous drugs not included in this table may still be appropriate for home administration dependent on individual patient assessment and suitability. REFERENCES 1. Brownlee, S; Lambert, J; McIlroy, I; Scullion, K; Miller, K; Coleman, A & Smith, E. (eds) (2008) HSC Northern Ireland Intravenous Medicines Administration Guide 2008 (First edition) 2. Medicines Information, Craigavon Area Hospital. Tel 028 38 612976 Email medicinesinfo.cah@southerntrust.hscni.net 3. Shulman, R; Drayan, S; Harries,M; Hoare,D & Badcott,S. (eds) (2005) Injectable Drug Administration Guide 2005. Blackwell Publishing. UCL Hospitals 4. Electronic Summaries of product Characteristics are available at: www.emc.medicines.org.uk 5. Manufacturers package inserts 6. Current BNF appendix 6: Intravenous additives 7. Medusa Injectable Medicines Guide. www.medusa.wales.nhs.uk 8. Medicines Complete. www.medicinescomplete.com. Pre and post NaCl flushes required: Cannula: 5mls, Midline/PICC line/portacath: 10mls