Intravenous Administration of ceftriaxone

We often have told our patients that IV push is not a good idea when using Ceftriaxone because the manufacturer recommends the drug infusion rate be over 30 minutes. While people have infused the product faster it is not recommended. We have included a page out of our reference describing the rate of infusion. Please see below

Important

This is the important part if you could not see it above. Under rate of administration, the manufacturers recommend that the intermittent IV infusions be infused over 30 minutes. 30 minutes  IV push takes a great deal of patience to complete correctly (not impossible, but difficult)

On a message board  called IV Therapy Net, there were questions about IV pushing Rocephin.  This is quite controversial, but as we reported above, IV push has not been recommended by the manufacturer.  Below is a comment made by  Ann Zonderman, BSN, JD, CRNI, LHRM, Infusion nurse specialist, Kindred on July 31, 2007 - 01:38.

FYI - It may not just  come down to the osmolarity and pH - I  worked on a legal case where the patient had 10 years of frequent IV mini bag Rocephin infusions and began to develop an allergy to the drug... the next dose given 2Gm in 10 cc syringe - IV PUSH  over 2 minutes - profound reaction happened minutes later , patient died .. moral:

 IF you are infusing with mini bag/tubing the rate of infusion will be slower - more control of the amount of drug administered... and you are able to observe signs / symptoms of adverse reaction as you infuse, and  possibly intervene to prevent a tragic outcome.

But for every view, there is an opposite opinion as reported below on the same message board: 

Submitted by Marianne, Nurse Manager, Option Care of Cumberland on August 2, 2007 - 05:09.

We have been giving Rocephin IV push for many years in the homes without incident.  Susan Poole, RN wrote an excellent article about IV push medications several years ago (1999 in JIN, Infusion, and ASHP).  Our guidelines for Rocephin are as follows:  1gram in 10ml sterile water (10mg/ml) slow IV push over 5 minutes via a PICC line.  If we have to give 2gm we  split the dose and give 1/2hr apart...never 2gm in such a short period of time; lately we have been giving 2gm in homepumps. Susan's article give references.  Rocephin mixed 1gm/10ml = 423 mOsm/kg.  Our policy also states may give IVPush to ages >11 yrs old.

It’s interesting to note that while the nurse that submitted this comment stated that “we have been giving Rocephin IV push for many years” she states now that “Lately we have been giving Rocephin 2GM in homepumps”.

There are physicians that recommend IV push for this drug, however we always want references and to date have not found a reference that states IV push is as safe as what the manufacturer recommends!

The bottom line is we can’t recommend a method of IV administration without valid references indicating the safety of the method of administration.  Since the FDA mandates certain procedures to insure safety, we recommend the manufacturers guidelines, which you can see above in the AHFS (American Hospital Formulary Service) information.