Originally Posted by lorijds
I don't see how if the abx is piggybacked or not makes any difference; the main line stops while the abx solution is running.
I work part time at a birth center and full time on the medical floor of the local hospital, and at both places we give antibiotics without additional IV fluids running. The antibiotic is, of course, not IV push; it's just mixed in small amount of carrier fluid (usually 50-100 mL normal saline, depends on the antibiotic, though) and given as per schedule. Note that when you set the pump, unless you have a multi-chamber pump, which is not standard in any place that I have ever worked with the exception of ICU, when you piggyback in a medication, the IV fluids that are running will stop until the programmed amount of antibiotic is in; then the IVF resume. So they have nothing to do with the actual infusion or dilution of the antibiotic. Do you see what I mean? Does that make sense?
I have also never heard of mixing PCN with lidocaine. You mean in the bag? Wouldn't that make it a lidocaine drip then? Wouldn't that have a potentially very detrimental effect on the maternal and fetal heart et respiratory rates? I agree with your other suggestions -- larger vein, room temp, slow the infusion rate -- but I am in the dark regarding mixing it with penicillin. Maybe it's something that is routinely done in some places, I don't know. But in our hospital we only use lidocaine for for certain heart arrhythmias, and then only in the ICU.
Yeah that, in regards to Jen's explanation of the difference in treatment modalities for vaginal vs urinary colonization for group B strep. Honestly, unless someone has alot of risk factors, at the birth center we don't worry much about group B strep, and don't have a problem at all with a mama refusing antibiotics. If a mama who had a bladder colonization refused antibiotics, I would be very uncomfortable with that, and would want her to understand the difference between a vaginal and a urinary tract colonization. Absolutely, it woul still be up to her to consent to or decline antibiotics; but to me there is a huge difference between a positive vaginal swab and a positive urine culture.
That doesn't condone your mw's attitude, though. Maybe it was just a bad day for her (we all have them), but she could have done a better job listening to you, and also explaining her reasoning to you. I'm sorry she wasn't more respectful and open to your questions and concerns. That's not okay.
If you watch a gravity main line, it doesn't stop entirely during the running of the antibiotics -- it does slow down (usually to TKO), but if it stops the abx are running too fast. We run the initial dose by gravity, then on a syringe pump. The mainline stays a gravity line for the most part, and I've never had a ML stop entirely during antibiotics. It could be different on a pump; sometimes I think pumps make things more complicated.
The concentration of lidocaine used for the mix we use is very low (brain fade on concentration). It's not enough to create cardiac effects, and I've never seen a change in FHTs after pen/lido. It does make a tremendous difference in pain, though, and it's used in most hospitals in our area because of that. At a birth center, though, I could see it being difficult to get unless you have an onsite pharmacist, because it doesn't last (24 hours, max) and has to be compounded (as far as I know, it's not commercially available).
There was a shortage of pen awhile ago, and we were using amp instead. It was q 6 hour dosing, and seemed to be less irritating.
doctorjen, you're right that the CDC recommends sensitivity testing for GBS cultures if the woman is pen allergic. However, their alternate antibiotic of choice for clinda-resistant strains is still vanco, which I've literally never seen given for GBS prophylaxis and to me implies a low (at least locally) prevalence of clinda resistance. We don't as a rule run cephalosporins on pen-allergic women, so we don't do cephalexin, but that would be an alternative that might be less irritating.