The bactericidal activity does not increase. In addition, the significance of a carbapenem post-antibiotic effect PAE against Gram-negative bacteria is highly disputed. Intermittent administration of a drug results in high peak and low trough serum levels. Some in-vitro and in-vivo studies of continuous infusion of ceftazidime 6 ,7 ,8 and meropenem published recently have demonstrated the effectiveness of continuous infusion. The present study was performed firstly to compare the pharmacokinetic parameters of meropenem by continuous infusion CI and intermittent administration IA in critically ill patients and secondly to determine the possibility of achieving therapeutic meropenem concentrations with a 3 g iv CI over 24 h.
The third aim was to study the applicability and side-effects of the IA regimen. The study was conducted in the intensive care unit of a teaching hospital. In accordance with ethical requirements, informed consent was obtained from patients or their next of kin. Fifteen critically ill patients four females, 11 males; Table I , admitted to the intensive care unit suffering from suspected or proven severe community or hospital acquired infection, were eligible for enrolment in the study.
Inclusion criteria demanded at least two of the following: Concomitant antimicrobial therapy with vancomycin was permitted to include cover for methicillin-resistant strains of Staphylococcus spp. The study was performed as a prospective, randomized, crossover trial. All patients were randomized to receive either a 2 g iv loading dose of meropenem followed by a daily 3 g continuous infusion CI; group 1 over 48 h or intermittent administration IA; group 2 of 2 g of meropenem iv every 8 h for 2 days.
After 2 days the patients received the alternative dose regimen. If necessary, vancomycin was added to cover methicillin-resistant staphylococci or enterococci. Steady-state concentrations of meropenem were expected to be achieved on day 2 of administration of CI or IA therapy. For group 1 meropenem was administered via an infusion pump Braun Melsungen, Melsungen, Germany. One gram of meropenem Optinem; Zeneca, Macclesfield, UK was reconstituted according to the manufacturer's guidelines and then diluted in 50 mL of isotonic saline solution.
New solutions were prepared every 8 h. The doses of 2 g of meropenem in group 2 were diluted in mL of isotonic saline solution and administered over 15 min. Blood samples were taken at 0, 0.
All blood samples were drawn from indwelling arterial catheters after discarding the first 10 mL of blood. Routine laboratory parameters e. Creatinine clearance was calculated by standard methods.
The concentration of meropenem in serum was determined by HPLC as described previously. The lowest detection limit was 0. The percentage recoveries from sera were The intra-assay reproducibility characterized by CV was 4.
The interassay reproducibility precision values calculated by CV were 3. Interference studies were carried out with many substances that might be administered with meropenem: None of these compounds was coeluted with meropenem during chromatography. During specificity studies all chromatograms were carefully checked for skewed shouldering, or tailing peaks. Pharmacokinetic parameters were compared with the two-tailed Student's t -test. Fifteen patients age Their creatinine clearance was No pathogens, with the exception of a coagulase-negative staphylococcus in one blood culture, were isolated during the study; no underlying infection was detected by microbiological tests.
The pharmacokinetic parameters for continuous and intermittent administration of meropenem are presented in Table II and the Figure. AUC and total meropenem clearance Cl tot showed statistically significant differences between groups 1 and 2. The Cl tot in the two patient groups was 9. The minimum concentration in the IA group was 8.
In between the doses, serum concentrations often fall below the MIC for the specific pathogen for a considerable time. The most effective administration mode of parenteral antibiotics remains controversial. Mean meropenem serum concentrations in the CI group at steady state were Related to intravenous infusion: This method of fluid replacement is used most often to maintain fluid and electrolyte balance, or to correct fluid volume deficits after excessive loss of body fluids, in patients unable to take sufficient volumes orally.
An additional use is for prolonged nutritional support of patients with gastrointestinal dysfunction total parenteral nutrition. Besides these uses, many medications are administered by intravenous infusion. A piggyback intravenous infusion is the intermittent delivery of an additional fluid or medication through the primary intravenous line from a second source of fluid with a secondary set of intravenous tubing.
Piggyback intravenous infusion set. Swelling of the limb around and distal to the site of injection may indicate that the tip of the catheter or needle is in the subcutaneous tissue and not in the vein.
The fluid may be infiltrating the tissue spaces. It should be withdrawn and the limb elevated. Redness, swelling, heat, and pain around the vein at the site of injection or proximal to it may indicate thrombophlebitis. The infusion should be discontinued and the inflammatory condition treated.
The infusion is usually begun again at another site. Common intravenous infusion sites. The injection into a vein of a solution, drugs, or blood components.
Site Intravenous infusion is usually given in the arm through the median basilic or median cephalic vein, but veins at various other sites may be used. Intravenous infusions should be discontinued or infusion fluid replenished when the solution being administered is depleted. Clotting of blood in the catheter may occur when the infusion is not continuous. Patient care Using scrupulous aseptic technique and universal precautions, the nurse prepares the IV infusion, selects and prepares a venous site, disinfects the skin, inserts an IV catheter or cannula to initiate the infusion if an IV access is not in place , and secures it in place, restraining joint motion near the insertion site as necessary.
This method of feeding is used most often when a patient is suffering from severe dehydration and does not drink fluids because it is unconscious, recovering from an operation, unable to swallow normally, or vomiting persistently.
Prolonged feeding of patients with chronic intestinal dysfunction can be accomplished by total parenteral nutrition. References in periodicals archive? Half the group was given standard anti-HIV medicines, while the other half got those drugs plus intravenous infusions of IL The optic neuritis therapy involves intravenous infusions of Ig once a day for five days and then once a month for three months.
Regaining vision lost to optic neuritis?
Besides these uses, many medications are administered by intravenous infusion. A piggyback intravenous infusion is the intermittent delivery of an additional fluid or medication through the primary intravenous line from a second source of fluid with a secondary set of intravenous tubing. Piggyback intravenous infusion set.
ADMINISTERING INTERMITTENT INTRAVENOUS MEDICATION USING A SECONDARY SET Definition: An intermittent infusion is a method of administering a medication mixed in a small amount of IV solution, such as 50 ml or ml.
Administering Intermittent Intravenous Medication (Secondary Medication) and Continuous IV Infusions Intravenous intermittent infusion is an infusion of a volume of fluid/medication over a set period of time at prescribed intervals and then stopped until the next dose is required. An infusion set for an intermittent or continuous administration of a therapeutical substance, such as insulin, comprises a cannula housing (1) with a soft plastic cannula (2) to be placed inside the body of a patient, where the cannula together with the cannula housing (1) form a through passageway the inlet of which into the cannula housing (1) is covered by a membrane.
Intravenous therapy (IV) is a therapy that delivers liquid substances directly into a vein (intra-+ ven-+ -ous). The intravenous route of administration can be used for injections (with a syringe at higher pressures) or infusions (typically using only the pressure supplied by gravity). secondary infusion Definition the administration of a parenteral drug that has been diluted in a small volume of iv solution(50 to ml) over 30 to 60 minutes.