Using Higher Doses to Compensate for Tubing Residuals in Extended-Infusion Piperacillin-Tazobactam. (June 2013)

• Record Type: Journal Article
• Authors: Lam, Wendy J; Bhowmick, Tanaya; Gross, Alan; Vanschooneveld, Trevor C; Weinstein, Melvin P
• Is Part Of: Annals of pharmacotherapy. Volume 47:Number 6(2013)
• Page Start: 886
• Page End: 891
• Publication Date: 2013-06
• Subjects: Chemotherapy -- Periodicals; Pharmacology -- Periodicals; 615.5805
• DOI: 10.1345/aph.1R721
• Languages: English
• ISSNs: 1060-0280

Abstract

OBJECTIVE: To mathematically assess drug losses due to infusion line residuals and evaluate methods to compensate for drug loss due to residual volumes in intravenous pump tubing. DATA SOURCES: Literature was accessed through Ovid MEDLINE (1996-February 2013), using combinations of the search terms tubing residuals, residual volume, residual medication, intravenous infusions, intravenous injections, piperacillin, piperacillin-tazobactam, β-lactams, equipment design, infusion pumps, extended infusion, extended administration, and prolonged infusion. In addition, select reference citations from publications identified were reviewed. STUDY SELECTION AND DATA EXTRACTION: All articles that involved extended-infusion piperacillin-tazobactam implementation strategies were included in the review. DATA SYNTHESIS: Infusion pump characteristics and tubing residuals can affect extended-infusion piperacillin-tazobactam dosing strategies. Two studies addressing tubing residuals were identified. Both studies recommended increasing infusion volumes to compensate for tubing residuals. One study also recommended decreasing infusion-line dead space by using alternative infusion pump systems. Study calculations suggest that higher doses of piperacillin-tazobactam may be used to account for medication left in tubing residuals if alternative infusion pump systems cannot be obtained, and increased infusion volumes are not an option. CONCLUSIONS: Extended-infusion piperacillin-tazobactam has been used as a method of maximizing pharmacodynamic target attainment. Use of higher doses of piperacillin-tazobactam may be a reasonable method to compensate for drug loss due to residual volumes in large-bore intravenous pump tubing.