Hospital Pharmacy - June 2018 - 164
164
administration via slow IV injection (eg, over 5-10
minutes).28,29 Phlebitis may occur if these agents are
injected too rapidly.60 Of note, profound hypotension has
been reported among patients receiving IV push administration of nafcillin during coronary artery bypass graft surgery,
presumed to be due to histamine-mediated vasodilation.120
Penicillin G and piperacillin/tazobactam are not recommended for IV push administration. Ampicillin/sulbactam is
recommended to be diluted in volumes that may preclude
practical administration via slow IV injection (eg, 1.5 g vials
in 50 mL to obtain maximum 30 mg/mL concentration).27
Although a study in 16 patients undergoing colorectal surgery reported IV push administration of 2 g/1 g ampicillin/
sulbactam over 3 minutes, the concentration of the solution
was not reported.121 Similarly to ampicillin, seizures may
occur with rapid administration of ampicillin/sulbactam.66
Finally, the monobactam aztreonam is indicated for IV push
administration after reconstitution of vials.23
Polymyxins
Colistimethate sodium can be administered IV push.25
After reconstitution, the manufacturer recommends use
within 7 days. However, colistimethate sodium can hydrolyze to colistin in aqueous solution. Although this conversion was minimally observed in one stability study (<1%
after storage of reconstituted solution at 4° or 25°C for 7 d
in the dark), the authors cautioned that reconstitution
should still be done as close to administration as possible,
and if it is necessary to store the solution, they recommend
storage at 4°C to minimize bacterial contamination.122
With regard to the safety of IV push administration, 1
patient out of 12 in a trial assessing the safety and tolerability of IV push colistimethate reported dizziness/lack of
coordination after receiving 160 mg in 10 mL over 5
minutes.123 This resolved when the patient was switched to
an intermittent IV infusion over 30 minutes. Polymyxin B
is FDA-approved to be given as an IV infusion, intramuscularly, or intrathecally.45 Administration of polymyxin B
over a period <30 minutes is not recommended, and rapid
IV injections should be avoided due to the potential for
nephro- or neurotoxicity.62,124
Tetracyclines
Doxycycline, minocycline, and tigecycline are recommended to be administered as an intermittent IV infusion and
are not suitable for IV push administration.42-44 The PIs for
doxycycline and minocycline specifically state that rapid
administration is not recommended, and oral administration
is preferred over parenteral administration.42,43 Phlebitis and
burning have been observed with more concentrated solutions of doxycycline.65,125
Hospital Pharmacy 53(3)
Others
Of the antibiotics that are not included in the classes already
discussed, only chloramphenicol can be administered IV
push.24 All of the other agents have specific statements against
IV push administration in at least one tertiary resource.60-63,65,66
Of note, Seifert and colleagues documented a report of severe
nausea, cramping, and hypotension after administration of
erythromycin 1 g in 100 mL of normal saline over 10 minutes.126 In addition, Aucoin and colleagues reported a case of
complete heart block following administration of clindamycin 600 mg over several minutes; the same patient tolerated
subsequent clindamycin infusions over 30 minutes without
incident.127 Rapid lincomycin administration has also been
associated with severe cardiac events including cardiopulmonary arrest.128
Linezolid and metronidazole are not available in a vial
formulation so these drugs are not practical to administer IV
push.6,51,52 One observational pharmacokinetic study documented rapid IV push of metronidazole 500 mg over 5 minutes, but the volume/concentration of the administered
solution was not specified so these data are not readily applicable to current clinical practice.129
Practical Considerations for IV Push
Antibiotics
Several organizations have issued guidance or recommendations for safe IV administration practices.130 The Institute for
Safe Medication Practices (ISMP) provides guidance on adult
IV push medication safety.131 Briefly, this guidance supports
preparation of IV push medications in the pharmacy so that a
ready-to-administer form can be provided to patient care
areas. In cases where immediate administration is required
for medication stability, preparation and dilution of the medication can occur in patient care areas. In those instances, dilution should take place in a clean, uncluttered area with clear
instructions on the type and volume of diluent that is needed.
Syringes should be promptly labeled; supplying blank, readyto-apply labels may help with adherence to that step.
Considerations for safe administration of IV push medications can be found in the ISMP guidance document. The 2016
Infusion Nurses Society (INS) Infusion Therapy Standards of
Practice largely mirror the ISMP recommendations for safe
preparation of medications for IV push administration.132
Osmolality is a concern when administering concentrated
solutions. The 2016 INS Infusion Therapy Standards of
Practice state that solutions with osmolality >900 mOsm/kg
should be administered through a central line and solutions
with osmolalities below this limit can be administered via
peripheral or midline catheters.132 The Standards of Practice
do not have any statements that connect osmolality and
administration rate; therefore, there does not seem to be any
Table of Contents for the Digital Edition of Hospital Pharmacy - June 2018
Ed Board
TOC
USP <800>
Oct-Dec 2017 Boxed Warning Highlights approved by the FDA
Zoster Vaccine Recombinant, Adjuvanted
Multifactorial Causes of Tacrolimus Errors: Confusion With Strength/Formulation, Look-Alike Names, Preparation Errors, and More
New Medications in the Treatment of Nonalcoholic Steatohepatitis
One Chance for Your Best First Impression: Tips for New Pharmacists
Implications of Statin Use on Vasopressor Therapy in the Setting of Septic Shock
Intravenous Push Administration of Antibiotics: Literature and Considerations
The Role of Computerized Clinical Decision Support in Reducing Inappropriate Medication Administration During Epidural Therapy
Health Care Professionals Toward Adverse Drug Reaction Reporting in Hiwot Fana Specialized University Hospital, Harar, Eastern Ethiopia: A Cross-sectional Study
Nonpharmacist Health Care Providers’ Knowledge of and Opinions Regarding Medication Costs in Critically Ill Patients
Detection of HBV, HCV, and Incidence of Febrile Neutropenia Associated With CHOP With or Without Rituximab in Diffuse Large B-Cell Lymphoma–Treated Patients
Hospital Pharmacy - June 2018 - Cover1
Hospital Pharmacy - June 2018 - Cover2
Hospital Pharmacy - June 2018 - Ed Board
Hospital Pharmacy - June 2018 - TOC
Hospital Pharmacy - June 2018 - 131
Hospital Pharmacy - June 2018 - USP <800>
Hospital Pharmacy - June 2018 - 133
Hospital Pharmacy - June 2018 - Oct-Dec 2017 Boxed Warning Highlights approved by the FDA
Hospital Pharmacy - June 2018 - 135
Hospital Pharmacy - June 2018 - Zoster Vaccine Recombinant, Adjuvanted
Hospital Pharmacy - June 2018 - 137
Hospital Pharmacy - June 2018 - 138
Hospital Pharmacy - June 2018 - 139
Hospital Pharmacy - June 2018 - 140
Hospital Pharmacy - June 2018 - 141
Hospital Pharmacy - June 2018 - Multifactorial Causes of Tacrolimus Errors: Confusion With Strength/Formulation, Look-Alike Names, Preparation Errors, and More
Hospital Pharmacy - June 2018 - 143
Hospital Pharmacy - June 2018 - 144
Hospital Pharmacy - June 2018 - 145
Hospital Pharmacy - June 2018 - New Medications in the Treatment of Nonalcoholic Steatohepatitis
Hospital Pharmacy - June 2018 - 147
Hospital Pharmacy - June 2018 - One Chance for Your Best First Impression: Tips for New Pharmacists
Hospital Pharmacy - June 2018 - 149
Hospital Pharmacy - June 2018 - 150
Hospital Pharmacy - June 2018 - 151
Hospital Pharmacy - June 2018 - Implications of Statin Use on Vasopressor Therapy in the Setting of Septic Shock
Hospital Pharmacy - June 2018 - 153
Hospital Pharmacy - June 2018 - 154
Hospital Pharmacy - June 2018 - 155
Hospital Pharmacy - June 2018 - 156
Hospital Pharmacy - June 2018 - Intravenous Push Administration of Antibiotics: Literature and Considerations
Hospital Pharmacy - June 2018 - 158
Hospital Pharmacy - June 2018 - 159
Hospital Pharmacy - June 2018 - 160
Hospital Pharmacy - June 2018 - 161
Hospital Pharmacy - June 2018 - 162
Hospital Pharmacy - June 2018 - 163
Hospital Pharmacy - June 2018 - 164
Hospital Pharmacy - June 2018 - 165
Hospital Pharmacy - June 2018 - 166
Hospital Pharmacy - June 2018 - 167
Hospital Pharmacy - June 2018 - 168
Hospital Pharmacy - June 2018 - 169
Hospital Pharmacy - June 2018 - The Role of Computerized Clinical Decision Support in Reducing Inappropriate Medication Administration During Epidural Therapy
Hospital Pharmacy - June 2018 - 171
Hospital Pharmacy - June 2018 - 172
Hospital Pharmacy - June 2018 - 173
Hospital Pharmacy - June 2018 - 174
Hospital Pharmacy - June 2018 - 175
Hospital Pharmacy - June 2018 - 176
Hospital Pharmacy - June 2018 - Health Care Professionals Toward Adverse Drug Reaction Reporting in Hiwot Fana Specialized University Hospital, Harar, Eastern Ethiopia: A Cross-sectional Study
Hospital Pharmacy - June 2018 - 178
Hospital Pharmacy - June 2018 - 179
Hospital Pharmacy - June 2018 - 180
Hospital Pharmacy - June 2018 - 181
Hospital Pharmacy - June 2018 - 182
Hospital Pharmacy - June 2018 - 183
Hospital Pharmacy - June 2018 - 184
Hospital Pharmacy - June 2018 - 185
Hospital Pharmacy - June 2018 - 186
Hospital Pharmacy - June 2018 - 187
Hospital Pharmacy - June 2018 - Nonpharmacist Health Care Providers’ Knowledge of and Opinions Regarding Medication Costs in Critically Ill Patients
Hospital Pharmacy - June 2018 - 189
Hospital Pharmacy - June 2018 - 190
Hospital Pharmacy - June 2018 - 191
Hospital Pharmacy - June 2018 - 192
Hospital Pharmacy - June 2018 - 193
Hospital Pharmacy - June 2018 - Detection of HBV, HCV, and Incidence of Febrile Neutropenia Associated With CHOP With or Without Rituximab in Diffuse Large B-Cell Lymphoma–Treated Patients
Hospital Pharmacy - June 2018 - 195
Hospital Pharmacy - June 2018 - 196
Hospital Pharmacy - June 2018 - 197
Hospital Pharmacy - June 2018 - 198
Hospital Pharmacy - June 2018 - 199
Hospital Pharmacy - June 2018 - 200
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