Random question ... our hospitals policy is to give nexium 40mg IV over "no less than 3 minutes"
I always dilute it in one of the 10ml NS syringes and give it slowly, but WHY?!?!
What happens if you give it fast? Does it matter one way or another if it is a peripheral vs central line?
Haley
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November 18th, 2008 at 8:45 pm
Hmm…interesting question. This set off a long search, I figured it would be in one of my references or findable with a quick google-search, but I’m having trouble finding the rationale. “Because the drug guide says so” is good enough for me right now, but I feel like we covered it back in school or something.
Let’s see what we can glean from the drug guide:
It looks like nexium is extensively metabolized by the liver (cytochrome P450 system, CY P2 C19 isoenzyme), maybe administering it too fast is hard on the liver, especially in the elderly and in so many other situations it’s just best to administer it slowly? Maybe they’re getting 3 grams of acetaminophen a day already with their PRN pain meds. Maybe they drink, who knows.
Also, it seems like the rate of administration has an effect on the speed at which gastric pH decreases, at least with the extended release PO form. Probably even faster IV. I could think of a bunch of reasons you’d want to adjust the gastric pH slowly rather than quickly, and it’s also important to point out this gastric pH change can screw with how PO meds are digested.
Let’s see…what else… Oh! Rapid administration of IV-Push medications can, in some cases, increase the likelihood and severity of adverse reactions. Nexium has some nasty ones, including nasty abdominal symptoms we probably don’t want cluttering up our assessments, especially considering that if they’re taking IV nexium already there are some important assessments to consider.
I think it’s just sort of a safety meta-principal that IV medications should be given slowly when possible. There’s more opportunity to catch an adverse reaction before the whole does is administered and it’s easier on the body. A great alternative to pushing IV meds I’ve seen is those syringe pumps, where you can put the med in a luer-lock syringe and set the pump to run it in over an hour or 20 minutes. Plug it into the secondary port in your IV line and you’re good to go. No playing with infusion settings or managing the VTBI and rate settings in the pump. Just make sure the fluids are compatible!
Also, remember that mixing a med with D5W instead of normal saline -may- cut it’s window of usability in half. In the case of nexium it’s 6 hours at room temperature in D5W, 12 hours at room temperature in NS.
November 19th, 2008 at 4:11 pm
Thanks for the info PM R.N.
December 14th, 2008 at 1:04 pm
thanks for your perspective! i guess ill just keep giving it slowly! haha