So the home infusion nurses at my IPPE site are pushing the docs/pharmacists to allow long-term use of ceftriaxone (and cefazolin) IV push in home care patients. My preceptor had me hunting for some literature to support this and I was only able to locate one article in one of the nursing journals that showed no significant difference in adverse events between cetriaxone administered via mini-bag or IV push. I talked to a few of the other pharmacists who said that, in their experience, some patients who received IV push experienced some cardiac/breathing issues and that it was generally not recommended.

These nurses want to do IV push because they say it is easier and faster. I know that normally we infuse ceftriaxone over 30 minutes and never have I seen us do an IV push on a patient at the hospital where I work (we have done IM with some lido added). I have only seen IV push of cefazolin before and I think it was on a peds patient.

I am wondering if any of you have experience with this.

Thanks in advance.

EDIT: and before y'all get gung ho on the HW help stuff, I already did my part at my rotation site (giving them the info I found). I am simply curious if you have seen this at all in practice.

They can be pushed.

We send out ceftriaxone "IV push" all the time... but it's considered a "slow IV injection" over 15 minutes.

It's definitely much easier and faster.

we give Ceftriaxone IM all the time.

My understanding was that the Beta-Lactams can all be given push if necessary - we run Cefazolin in wide open (not on a pump or anything) in traumas all the time. It's really just when you're doing extended infusion that infusion time really "matters".

thanks guys. That's really helpful. I'm just a lowly soon-to-be 2nd year student so I am pretty much getting pimped on a daily basis at my IPPE site. It's awesome! And I don't mean that in a sarcastic way.

So the home infusion nurses at my IPPE site are pushing the docs/pharmacists to allow long-term use of ceftriaxone (and cefazolin) IV push in home care patients. My preceptor had me hunting for some literature to support this and I was only able to locate one article in one of the nursing journals that showed no significant difference in adverse events between cetriaxone administered via mini-bag or IV push. I talked to a few of the other pharmacists who said that, in their experience, some patients who received IV push experienced some cardiac/breathing issues and that it was generally not recommended.

These nurses want to do IV push because they say it is easier and faster. I know that normally we infuse ceftriaxone over 30 minutes and never have I seen us do an IV push on a patient at the hospital where I work (we have done IM with some lido added). I have only seen IV push of cefazolin before and I think it was on a peds patient.

I am wondering if any of you have experience with this.

Thanks in advance.

EDIT: and before y'all get gung ho on the HW help stuff, I already did my part at my rotation site (giving them the info I found). I am simply curious if you have seen this at all in practice.

I recently spoke with a patient who was being given Invanz IVP.

Yeah we do Invanz IVP a lot at the hospital (relatively speaking).

Slow IV push over 15 to 30 min for peds (on a pump, though). Adults 1 and 2 grams premix in d5 50 ml. We never push it, but it can be slow iv push. Why can't they hang it?

Slow IV push over 15 to 30 min for peds (on a pump, though). Adults 1 and 2 grams premix in d5 50 ml. We never push it, but it can be slow iv push. Why can't they hang it?

They want to push it faster than 30 minutes and don't want to hang it because, well, I guess they think it is easier and faster to push. Damn nurses ;)

I don't have any sources off hand, but I've seen lots of places give cefazolin IVP with no problems. I believe there's an article in ASHP about Rocephin IVP but we usually give it IVPB. Although I've seen an RN mistakenly give it push in the ED which resulted in a lot of infusion site pain.

Another factor you have to consider the type of line that's going to be used. IVP into a PICC isn't the same as a peripheral or midline especially since the primary concern here is phlebitis. (Never heard of CV effects, but it's possible.)

Why do they even want to give it push? I thought these homecare folks put like a weeks worth of drug in one bag and the patient just wore a backpack with the drug and pump; then it was infused with preset rates and times.

I don't have any sources off hand, but I've seen lots of places give cefazolin IVP with no problems. I believe there's an article in ASHP about Rocephin IVP but we usually give it IVPB. Although I've seen an RN mistakenly give it push in the ED which resulted in a lot of infusion site pain.

Another factor you have to consider the type of line that's going to be used. IVP into a PICC isn't the same as a peripheral or midline especially since the primary concern here is phlebitis. (Never heard of CV effects, but it's possible.)

Why do they even want to give it push? I thought these homecare folks put like a weeks worth of drug in one bag and the patient just wore a backpack with the drug and pump; then it was infused with preset rates and times.

Thanks. I will ask for more clarification tomorrow when I go to my rotation. The point about the PICC vs peripheral vs midline is a good one. I will also ask about that tomorrow. I'll see if I can find that article.