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UW Health Anesthesia Table for OR Antibiotics: Preparation and consideration for IV push administration

UW Health Anesthesia Table for OR Antibiotics: Preparation and consideration for IV push administration - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Clinical Practice Guidelines, Infection and Isolation, Related


1
Appendix B. UW Health Anesthesia Table for OR Antibiotics: Preparation and consideration for IV push administration
From: Surgical and Interventional Radiology Antimicrobial Prophylaxis Clinical Practice Guideline
Last reviewed: 11/2017
Contact information: Philip Trapskin, PharmD; (608)-263-1328, PTrapskin@uwhealth.org
All antibiotics should be prepared prior to case, labeled appropriately, and discarded if unused.
Appropriate labeling consists of:
(1) Name and concentration (strength) of the medication or solution;
(2) Volume/amount (if not apparent from the container);
(3) Diluent name and volume (if not apparent from the container);
(4) Expiration date (if it is not to be used within 24 hours); and
(5) Time of expiration (if it is fewer than 24 hours)
Do not use 0.9% sodium chloride flushes for drug dilution and product preparation.
1

Drug Reconstitution Intravenous (IV) Push Time
Ampicillin 1 g
2,3
Reconstitute each vial with 7.4 mL sterile water for injection
• Administer doses less than 500 mg over 3 to 5 minutes
• Administer doses of 1-2 g over 10-15 minutes
• More rapid administration may result in seizures
Ampicillin 2 g
2,3
Reconstitute each vial with 14.8 mL sterile water for injection
• Administer doses less than 500 mg over 3 to 5 minutes
• Administer doses of 1-2 g over 10-15 minutes
• More rapid administration may result in seizures
Ampicillin/
sulbactam 1.5 g
(Unasyn)
2,3

Reconstitute each vial with 3.2 mL of sterile water for injection.
Reconstituted solution should be diluted further in 0.9% sodium chloride
(normal saline) to yield a concentration between 3 and 45 mg/mL
(ampicillin sodium 2 to 30 mg/mL and sulbactam sodium 1 to 15
mg/mL).
Administer by slow IV push over 10 to 15 minutes
Ampicillin/
sulbactam 3 g
(Unasyn)
2,3

Reconstitute each vial with 6.4 mL of sterile water for injection.
Reconstituted solution should be diluted further in 0.9% sodium chloride
(normal saline) to yield a concentration between 3 and 45 mg/mL
(ampicillin sodium 2 to 30 mg/mL and sulbactam sodium 1 to 15
mg/mL).
Administer by slow IV push over 10 to 15 minutes
Cefazolin 1 g
2,3
Reconstitute each 1 g vial with 7.5 mL sterile water for injection
• Administer by slow IV push over 3 to 5 minutes
• Thrombophlebitis can occur
• Diluted solution should be translucent and yellow
Cefazolin 2 g
2,3

• Cefazolin 2 gram DUPLEX
®
bag system: directions to reconstitute
• Or use two 1 gram vials: instructions above
• Duplex bag: administer over 30 to 60 minutes
• Vials: administer each 1 g dose by slow IV push over 3 to 5
minutes
Cefazolin 3 g
2,3
Use three 1 gram vials; instructions above Administer each 1 g dose by slow IV push over 3 to 5 minutes
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

2

Drug Reconstitution Intravenous (IV) Push Time
Cefepime 1 g
2-4

Reconstitute each 1 g vial with 10 mL sterile water for injection or 0.9%
sodium chloride (normal saline).
Reconstituted solution should be diluted further in 0.9% sodium chloride
(normal saline) to yield a concentration between 1 and 40 mg/mL.
• Administer by slow IV push over 5 minutes.
• Localized phlebitis can occur

Cefepime 2 g
2-4

Reconstitute each 2 g vial with 10 mL sterile water for injection or 0.9%
sodium chloride (normal saline)
Reconstituted solution should be diluted further in 0.9% sodium chloride
(normal saline) to yield a concentration between 1 and 40 mg/mL.
• Administer by slow IV push over 5 minutes.
• Localized phlebitis can occur
Ceftriaxone 1
g
2,3,5-7

Reconstitute each vial with 9.6 mL sterile water for injection or 0.9%
sodium chloride (normal saline)

• Administer by slow IV push over 3 to 5 minutes in adult
patients or
• IV push only in patients 12 years of age and older
• Do not administer simultaneously with calcium-containing
solutions (e.g. Lactated Ringer’s or Hartmann solution),
products, or continuous calcium-containing infusions (e.g.
parenteral nutrition) in the same IV line or Y-site due to risk of
precipitate formation

Ceftriaxone 2
g
2,3,5,6

Reconstitute each vial with 19.2 mL sterile water for injection or 0.9%
sodium chloride (normal saline)


• Administer by slow IV push over 5 minutes in adult patients
• IV push only in patients 12 years of age and older
• Do not administer simultaneously with calcium-containing
solutions (e.g. Lactated Ringer’s or Hartmann solution),
products, or continuous calcium-containing infusions (e.g.
parenteral nutrition) in the same IV line or Y-site due to risk of
precipitate formation
Cefoxitin 1 g
2,3
Reconstitute each 1 g vial with 10 mL sterile water for injection Administer by slow IV push over 3 to 5 minutes
Cefoxitin 2 g
2,3
Reconstitute each 2 g vial with 10 mL sterile water for injection Administer by slow IV push over 3 to 5 minutes
Cefoxitin 3 g
2,3

Reconstitute a 1 g vial and a 2 g vial each with 10 mL of sterile water for
injection
• Administer each 1 g dose by slow IV push over 3 to 5 minutes.
• Administer each 2 g dose by slow IV push over 3 to 5 minutes.
Cefuroxime 1.5
g and 3 g
2,3

Reconstitute each 1.5 gram vial with 16 mL of sterile water for injection.
Shake gently.
• Administer each 1.5 g dose by slow IV push over 3 to 5
minutes.
• Local thrombophlebitis can occur.
Clindamycin 600
mg, 900 mg or
1200 mg bag
2,3,8

Provided as a premade bag in the OR pharmacies
Cannot be administered by IV push. Administer no faster than
30 mg/min. Do not exceed 1,200 mg/hour.
Doxycycline 100
mg
2,3,8

Either use 100 mL minibag plus bag or, if unavailable, reconstitute vial
with 10 mL sterile water for injection or 0.9% sodium chloride and
further dilute to 100 mL.
Cannot be administered by IV push. Must be given over 1 hour.
If 100 mL bag is not available, obtain from pharmacy.
Gentamicin 40
mg/mL vials
2,3,8

Dilute dose in 50 mL to 100 mL of 0.9% normal saline. Obtain product
from pharmacy if bags unavailable. Maximum concentration < 10
mg/mL.
Cannot be administered by IV push. Doses less than 250 mg
may be given over 30 minutes, doses greater than 250 mg
administer over 60 minutes.
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

3

Drug Reconstitution Intravenous (IV) Push Time
Piperacillin/
Tazobactam
3.375 g
(Zosyn)
2,3,8

Either use 100 mL minibag plus bag, advantage vial with advantage
bag, or contact pharmacy for product. Reconstitute vial with 15 mL
sterile water for injection or 0.9% sodium chloride and further dilute to
50 to150 mL. Maximum recommended volume per dose of sterile water
for injection is 50 mL.
Cannot be administered by IV push. Administer over at least 30
minutes.
Piperacillin/
Tazobactam 4.5
g
(Zosyn)
2,3,8

Either use 100 mL minibag plus bag, if unavailable contact pharmacy
for product. Reconstitute vial with 20 mL sterile water for injection or
0.9% sodium chloride and further dilute to 50-150 mL. Maximum
recommended volume per dose of sterile water for injection is 50 mL.
Cannot be administered by IV push. Administer over at least 30
minutes.
Vancomycin
2,3,8
Use bags provided by pharmacy.
Cannot be administered by IV push. Must use infusion pump to
prevent systematic histamine release and hypotension. Administer
500 mg to 1 gram doses over 60 minutes, 1.5 gram doses over 90
minutes, and 2 gram doses over 120 minutes.

References
1. Institute for Safe Medication Practices (ISMP). ISMP Safe Practice Guidelines for Adult IV Push Medications. Institute for Safe Medication Practices (ISMP) website.
https://www.ismp.org/Tools/guidelines/IVSummitPush/IVPushMedGuidelines.pdf. 2015. Accessed November 8, 2017.
2. LexiComp Online, Hudson, Ohio: Wolters Kluwer Clinical Drug Information, Inc.; 2017; Accessed November 8, 2017.
3. Trissel's™ 2 Clinical Pharmaceutics Database Online, Hudson, Ohio: Wolters Kluwer Clinical Drug Information, Inc.; 2017; Accessed November 8, 2017.
4. Garrelts JC, Wagner DJ. The pharmacokinetics, safety, and tolerance of cefepime administered as an intravenous bolus or as a rapid infusion. Ann Pharmacother. Dec
1999;33(12):1258-1261.
5. Baumgartner JD, Glauser MP. Single daily dose treatment of severe refractory infections with ceftriaxone. Cost savings and possible parenteral outpatient treatment. Arch
Intern Med. Oct 1983;143(10):1868-1873.
6. Poole SM, Nowobilski-Vasilios A, Free F. Intravenous push medications in the home. J Intraven Nurs. Jul-Aug 1999;22(4):209-215.
7. Garrelts JC, Ast D, LaRocca J, Smith DF, Peterie JD. Postinfusion phlebitis after intravenous push versus intravenous piggyback administration of antimicrobial agents. Clin
Pharm. Oct 1988;7(10):760-765.
8. Bouchard CA. Intravenous Administration of Formulary Medications – Adult– Inpatient/Ambulatory – Clinical Practice Guideline. UW Health website.
https://www.uwhealth.org/cckm/?path=/cckm/cpg/medications/name-97579-en.html. November 2017. Accessed November 8, 2017.
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org