Diluting cefazolin

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Ive been using ringers or ns for years to dilute this. One of my partners pointed out just now the monograph says it must be sterile water.
Anyone any data on this?

 

[NICMAN]

Tell him your nursing supervisor said it was OK.

 

[Southpaw]

Saline or LR for 10 years no issues

 

[ucladoc2b]

Ive been using ringers or ns for years to dilute this. One of my partners pointed out just now the monograph says it must be sterile water.
Anyone any data on this?

So it can be injected into an IV carrier delivering NS, LR or plasmalyte?

 

[jwk]

So it can be injected into an IV carrier delivering NS, LR or plasmalyte?

Of course you can - we use LR for just about every IV and everything goes through it - fluid, blood, drugs, etc. We don't do the "you have to have a second IV because you have two antibiotics" nonsense.

 

[nimbus]

It might matter if it’s sitting in a bag while infusing over an hour or 3 hours but not when you mix it up and inject it in 30 seconds.

The kiwis and the Canadians say it’s compatible with everything and I believe them.

https://www.medsafe.govt.nz/profs/datasheet/c/cefazolinaftinj.pdf

https://www.ismp-canada.org/SafeHomeInfusion/download/Monograph-IV-Cefazolin.pdf

 

[Onefellswoop87]

Had a peds anesthesiologist tell me when I was a resident to reconstitute it in sterile water cause even that makes it slightly hypertonic, so reconstituting it in NS or LR makes it way too hypertonic. Seems reasonable for tiny veins but does it matter? Dunno

 

[GassYous]

I only use sterile water as your partner says because as soon as the medication hits the veins it remains in a completely electrolyte free environment.

 

[Planktonmd]

I think to be safe we may need to drain the blood and replace it with sterile water so we can be sure that cefazoline is not exposed to anything that is not recommended in the monogram. One problem though... when it reaches the tissue it might get in contact with things other than sterile water, so we need to figure out a way to avoid this violation of pharmacy policies.

 

[deleted875186]

CEFAZOLIN FOR INJECTION, USP

dailymed.nlm.nih.gov

Package insert says dilute in sterile water for bolus, but also says you can dilute in 50 mL of LR or saline or various other IV fluids for infusion, so it is clearly compatible, may just not be isotonic if you take 2 grams and put in a 10 cc saline flush and push it.

 

[repititionition]

if this practice were causing phlebitis or sclerosis, I am confident that we’d know about it, as ancef is without question among the most commonly administered medication in ORs across the country.

 

[Iso4ane]

I think to be safe we may need to drain the blood and replace it with sterile water so we can be sure that cefazoline is not exposed to anything that is not recommended in the monogram. One problem though... when it reaches the tissue it might get in contact with things other than sterile water, so we need to figure out a way to avoid this violation of pharmacy policies.

Why dilute it at all? Just have the patient sniff it.

 

[pgg]

Had a peds anesthesiologist tell me when I was a resident to reconstitute it in sterile water cause even that makes it slightly hypertonic, so reconstituting it in NS or LR makes it way too hypertonic. Seems reasonable for tiny veins but does it matter? Dunno

This is the reason for the manufacturer's recommendation.

I doubt it matters for the most part. Lots of the drugs we inject are anything but isotonic.

At the extreme end we've got 8.4% sodium bicarb, which has twice the osmolarity of 3% hypertonic saline, but I don't think anyone ever worries about giving that. You'd have to dilute a 50 mL amp of it in something like 350 mL of water to make it isotonic. Ain't nobody got time for that.

 

[narcusprince]

I actually draw my ancef up in 10cc of blood so I know its in its destination environment. Prove me wrong. Lol

 

[DrOwnage]

They also recommend to give IV acetaminophen over 15 minutes and I boom that **** in like a beer bong.

 

[Iso4ane]

This is the reason for the manufacturer's recommendation.

I doubt it matters for the most part. Lots of the drugs we inject are anything but isotonic.

At the extreme end we've got 8.4% sodium bicarb, which has twice the osmolarity of 3% hypertonic saline, but I don't think anyone ever worries about giving that. You'd have to dilute a 50 mL amp of it in something like 350 mL of water to make it isotonic. Ain't nobody got time for that.

10% Calcium Chloride is even higher. And You don't have to push it down to isotonic. From what I recall if you can get it down to ~750mOsm/L you reduce the risk of thrombophlebitis.

 

[nimbus]

This is the reason for the manufacturer's recommendation.

I doubt it matters for the most part. Lots of the drugs we inject are anything but isotonic.

At the extreme end we've got 8.4% sodium bicarb, which has twice the osmolarity of 3% hypertonic saline, but I don't think anyone ever worries about giving that. You'd have to dilute a 50 mL amp of it in something like 350 mL of water to make it isotonic. Ain't nobody got time for that.

10% Calcium Chloride is even higher. And You don't have to push it down to isotonic. From what I recall if you can get it down to ~750mOsm/L you reduce the risk of thrombophlebitis.

That’s why every patient deserves a cordis dumping into the SVC/RA junction 😉

 

[UscGhost]

I actually draw my ancef up in 10cc of blood so I know its in its destination environment. Prove me wrong. Lol

Your blood or the patient's?

 

[Radetzky]

I inject the powder straight

 

[2Fast2Des]

I inject the powder straight

Why mix yourself when you can let the ancef pump in the chest do it for you!

 

[DocVapor]

Why dilute it at all? Just have the patient sniff it.

Careful, the surgeon might start thinking it's cocaine and want a hit himself.

 

[nimbus]

Careful, the surgeon might start thinking it's cocaine and want a hit himself.

Ancef snorting trending on TikTok

 

[DrAmir0078]

Ive been using ringers or ns for years to dilute this. One of my partners pointed out just now the monograph says it must be sterile water.
Anyone any data on this?

Check "Gahart's INTRAVENOUS MEDICATIONS, A Handbook for Nurses and Health Professionals", it has a perfect table at the end of it titled "Solution Compatibility Chart", you may see your medication is listed and both NS and R or RL are Compatible.