Extended Infusion Beta-lactams for Nurses

You see your patients all day, every day. Let's get them the most appropriate therapy we can.

Why are we doing this?

The

Time above the minimum inhibitory concentration (MIC) is the most important factor for effectiveness of beta-lactam antibiotics. The longer the drug concentration is above the MIC, the better bacterial killing effect. With rising antimicrobial resistance, optimizing the effectiveness of antibiotics we have available in Canada is critical.

What's new?

With the new process, every patient will get a first dose of either piperacillin/tazobactam or meropenem over 30 minutes
No big change there.

The two big changes:

the 2nd dose will be given earlier*
2nd and subsequent doses will be given over 3 hours

Note: Timeline may differ in setting of renal dysfunction.
See dosing tables below for complete information

What do I do?

The

Check Powerchart if inpatient, check the ED MAR if transferred. There are new order sets built to support timing and infusion duration.
Find a smart pump. You'll need it for the 3-hour infusion, and the libraries are updated to reflect the change in infusion duration.
Check IV access and drug/fluid compatibility. There are 4 common scenarios to consider:
- Single vascular access, no other medications: no issue, run as primary or secondary.
- Single vascular access, other medications: if possible, schedule around antibiotic infusions
- Single vascular access, other compatible medications that cannot be rescheduled: use 2 pump channels with J-set
- Single vascular access, incompatible medications: obtain a second vascular access (note that separate lumens of PICC/central lines can be used for incompatible solutions)
Start the infusion.
Make sure to flush the line after the infusion is complete to ensure patients receive all the antibiotic.
If you can’t do a 3-hour infusions, talk to the prescribers. It may be reasonable to change to 30-minute infusions or an alternative antibiotic depending on the patient.

For more information, check out the files below:

Have questions? Talk to your charge nurse, clinical nurse specialist, pharmacist or email us at antimicrobial.stewardship@sinaihealth.ca

What do I do?

The

Check Powerchart if inpatient, check the ED MAR if transferred. There are new order sets built to support timing and infusion duration.
Find a smart pump. You'll need it for the 3-hour infusion, and the libraries are updated to reflect the change in infusion duration.
Check IV access and drug/fluid compatibility. There are 4 common scenarios to consider:
- Single vascular access, no other medications: no issue, run as primary or secondary.
- Single vascular access, other medications: if possible, schedule around antibiotic infusions
- Single vascular access, other compatible medications that cannot be rescheduled: use 2 pump channels with J-set
- Single vascular access, incompatible medications: obtain a second vascular access (note that separate lumens of PICC/central lines can be used for incompatible solutions)
Start the infusion.
Make sure to flush the line after the infusion is complete to ensure patients receive all the antibiotic.
If you can’t do a 3-hour infusions, talk to the prescribers. It may be reasonable to change to 30-minute infusions or an alternative antibiotic depending on the patient.