Vancomycin HCl 0.3g IV intermittent infusion, for a child with methicillin resistant Staphylo-coccus aureus infection (MRSA). Child's weight: 30 kg SDR: Infants and children. 40 mg per kg per day in divided doses q 6-8 hr not to exceed 5 mg per mL
concentration. Available from pharmacy: An IV piggyback solution of 60 mL containing 300 mg of Vancomy-cin with directions to infuse over 30 minutes.
a. SDR for this patient:DA:
b. Evaluation:
c. Is the pharmacy-supplied dilution safe for 0.3 g drug according to the label directions? DA:
d. Flow rate on pump in mL per hr based on pharmacy directions.Estimate: DA:
e. Evaluation:
a. 40 x 30 = 1200 total mg per day ÷ 6 = 200 mg per dose or ÷ 4 = 300 mg per dose
b. Safe. The label says that 500 mg must be prepared in 100 mL solution. 300 mg can be pre-pared in 60 mL solution.
c. Flow rate on pump in mL per hr: estimate: 120 mL per hr would deliver 60 mL in hour.
d. DA verification:
e. Tip: Pharmacies usually prepare these "piggyback solutions," however, it is good for the nurse to understand why first and second dilutions are often necessary and how they are han-dled. The first dilution is to just to get the powder mixed with sufficient diluent so that only the amount of drug needed can be withdrawn: When a second dilution is required as with this drug, the purpose is to make the solution a safe concentration to administer. Once you have the correct dose in solution, the flow rate is based on the order and the mL available.
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