LymeNet Flash: Need a nurse or doctors input

This is topic Need a nurse or doctors input in forum Medical Questions at LymeNet Flash.

To visit this topic, use this URL:
https://flash.lymenet.org/ubb/ultimatebb.php/topic/1/24705

Posted by WildCondor on :

I am curious for a friend of mine if you can use the powdered rocephin that you would mix with lidocaine to do an IM shot, and mix it with saline instead and do an IV push? Any nurses/doctors on here that can answer this.

Seems like doing the IV push method could be a good alternative if your insurance wont pay for IV, and but you have an IV line and can pay for the Rocephin yourself.

Can anyone explain the IV push directions, how m uch you mix, if saline is used, if you need lidocaine for anything, and if you need heparin for a flush after for a PICC or midline? Also, if Rocephin IM shots are ever done daily? Thank you.

------------------
Lyme Disease Help
http://www.wildcondor.com

Posted by k-lyme (Member # 5574) on :

I'm no doctor, but I sure as hell could be.---- DO NOT MIX ROCEPHIN W/ LIDOCAINE!!!! Bad, very,very bad. It is okay to mix the Rocephin w/ saline, %5 dextrose, or sterile water for either IM or IV push. I am on IV Rocephin right now so this is how I know. don't bother with the IM. It is very in effective that way because the antibiotic is injected into the muscle where there is a chance it can be metabolized by the underlying spirochetes living there. See with the IV, that doesn't go straight into the muscle but rather the vein and has a more effective chance of killing those bastards off! Believe me, if you are going to spend that much money for the studd, you want it to work the best way it can! ---Good luck

Posted by TX Lyme Mom (Member # 3162) on :

I'm no doctor nor nurse, nor do I play one on TV.

However, I do have experience with both IV and IM Rocephin. Therefore, I do know that for doing IM Rocephin, you must mix it with lidocaine. (I assume that the lidocaine is really a saline mixture with a wee bit of the lidocaine added into it, but I don't have a bottle of it in front of me, so I can't check the label to see what it says exactly.)

As for doing the "push" method, if I recall what a friend did, then it was mixed with saline (not lidocaine) and injected straight into the vein. This friend had a mid-line type PICC, so the little dangley thingies were accessible enough to manage to self-inject, but it requires some dexterity, not to mention having enough patience to time it properly. It's also necessary to do the "Hep-Lock" method after injecting, same as you would if it were any other method of infusion.

They ordered all their injection supplies from a pharmacy by mail order. The push method eliminated the need for tubing, but you still pre-mix the dry Rocephin into the a small amount of saline first, since you are still using the same identical vials of dry form Rocephin to start out with. Next, you add this "reconstituted" liquid mixture, composed of Rocephin plus the tiny amount of saline from the vial, into the larger amount of saline in the syringe, prior to injecting it into the vein via the PICC line.

Frankly, I'd check into mixing it into the saline bags and using the old-fashioned gravity flow drip method instead. The only extra items you would need for doing it that way are the tubing plus the connecting devices, called "valve ports". Obtaining the little valve ports, which are about 1" long and 1/4" in diameter, was the difficult part, because no one wanted to sell them to us. It seems as if this specialty item are sold only through distributors and to purchase them involves "contract pricing" schemes, which to my mind are probably in violation of anti-trust laws and should be investigated by the Federal Trade Commission, since the FDA seems to be turning a blind eye on this nefarious practice and/or even condoning it.

If it weren't for these "contract pricing" schemes, then the cost for home health service would be much, much lower indeed, by several fold. Congress was investigating aspects of this a couple of years ago, but I don't think they ever got to the bottom of it because they were investigating hospitals only and didn't look at the home health care industry -- to the best of my knowledge.

I didn't follow that investigation too closely because I had too much else on my plate at the time. I just know that there were hearings about it, but I never did know the outcome of that Congressional committee's summary report. Shame on me for failing to follow up on this. I had intended to do so, but never managed to do it for a variety of reasons.

Posted by cindy_leigh (Member # 3514) on :

some things to think about:

Has your friend ever had Rocephin before? I sure would not want an abx IV push if I had never had it. If an allergic rxn were to occur, you've got a full dose on board, IV, versus a drip, where you could stop it in time to perhaps save your life. Giving abx IV push is not a standard practice.....

Posted by TX Lyme Mom (Member # 3162) on :

Thank goodness for Cindy's careful response. She read you post more carefully that I did and remembered that you were asking for the sake of a friend. I glossed over that part and was thinking in terms of answering for you, as an already experienced patient who has already had a lot of abx.

Do pay attention to what Cindy has said because she has a very valid point.

Posted by docdave130 on :

i'm a doctor and a nurse and don't have the foggiest notion of an answer but i was bored and had to write something
sorry folks
little humor very little humor

Posted by WildCondor on :

My friend has no allergy to Rocephin and is on IV Rocephin now.

I just was wondering about how it is mixed to do an IV push.

As for the lidocaine, the information k-lyme posted is wrong. I did IM Rocephin shots for months and you have to mix it with lidocaine. Also, the IM Rocephin is very effective! I herxed on it right after the shots. Its strong medicine, no doubt.

Okay, thank you for the replies.
Yes, this question is not for me, but I am curious.

------------------
Lyme Disease Help
http://www.wildcondor.com

Posted by kaos (Member # 4144) on :

Actually, the question is for me and Wildcondor is being near and dear by asking for me. My insurance will no longer cover I.V. Rocephin that I have done through a mid-line. The mid-line will be good for several months, so I'm purchasing rocephin bottles and doing an abx push. Once this line is taken out, I'll probably never get another chance.

I just looked at my prescription and it says rocephin mixed with NaCl. That answers that. I think lidocaine is used for IM injections, and saline is used for this.

I'll also have to hire my own nurse to come and change the dressing over the mid-line. Obviously my insurance company is not working on my side.

Posted by lightfoot (Member # 2536) on :

Hi!!

From our experience I'd like to mention two things that might interest you.

1) Whether doing rocephin by IV or Push, the infusion time is very important!!!! Miss lightfoot & I both had severe reactions from infusing by the Push method TOOOOOO fast. AND we were following the directions we were given by the medical professionals. Slower infusion by any method is always safer.

2) You can learn to do your own dressing changes over the midline or have a friend or family member do it. That can save you a bundle!!! Even if you have to hire your own nurse to come once or twice and teach you, it's a deal!!

Good luck......lightfoot

------------------
C O L O R A D O * S U P P O R T * S Y S T E M
[email protected]

"A friend is someone who knows the song in your heart
and can sing it back to you when you have forgotten the words".
Unknown

Posted by once bitten on :

I think lidocaine into the heart might kill you...I know the bottle warns not to swallow it, you won't be able to work your muscles to swallow when the nerve deadening properties kick in, and I know if you push bicillin into your IV it prob will kill you, altho its then the bicillin doing it.. so I certainly wouldn't ever put lidocaine into my heart.

Posted by debi (Member # 5542) on :

hello,
i just wanted to write to you you let you know about your midline, i have worked for a home iv company for 12 yrs now. as for your midline , no matter what med you are using you want to flush 1st w/ saline, run your dose of abx, flush w/ saline again, and definitely finish w/ a heprin flush. if you do not use the heprin your line can clot.
i do agree that having a home nurse once a week or every other week would be fine. the nurse can teach a family member to change it VERY EASY, and tello you of the signs to watch for if your line were to be infected. also they could , and usually will set up the 1st visit w/ you and sit threw the dose w/ you. they know all the signs, and can stop a reaction in a instant if needed, they, or all the nurses for my company come w/ epipens. sorry if i am rambling, but i am very tired, if you need any answers feel free to write me. hope this helped debi

Posted by liz28 on :

I'm no doctor, but I did do the "push" for a few months, and saved a bundle. The rocephin was only mixed with saline, and had to be pushed in VERY, VERY SLOWLY, over the course of an hour or two. It was one black line's worth on the syringe for every five minutes. When I first started, I tried to cheat by speeding up and doing a push every three minutes, and passed out for an hour. There are other threads on this site about this topic--check it out.

Posted by k-lyme (Member # 5574) on :

WildCondor--- No, I am not wrong! It is dangerous injecting lidocaine when it isn't used for anesthetic purposes. It can cause abnormal heart beats and bad stuff can happen

Posted by skeezixdoc (Member # 5027) on :

k-lyme,
technically you're correct about not injecting lidocaine. However, you're using it out of context a little. Lidocaine is used IV for heart arrythmias, but in higher doses than for in the instance noted here.

Lidocaine used for local anesthesia, as it's described in this thread, mixed in with rocephin is very dilute. An entire vial is only 200mg total. This means you'd have to inject the entire vial to cause toxicity in an average man of 150-160 pounds. You only need about a half ml of this lidocaine, which is only 5mg.

Lidocaine is used also with IV infusions at times, like when the drug being infused causes a burning sensation in the veins. Again, the dose is very low and diluted. I just wanted you to understand the difference for your own interest.

Posted by WildCondor on :

I was talking about IM use, not IV. :-)
Lidocaine(2-3 cc) is used to mix into powdered Rocephin(1 gram) and injected into the butt muscle. Its gradually absorbed, not injected into a vein.

[This message has been edited by WildCondor (edited 23 April 2004).]

Posted by k-lyme (Member # 5574) on :

Thanks skeezixdoc

Posted by Lynn Lymemom (Member # 19) on :

We were told to **never** do IV push faster than over 20 minutes. Many here keep saying to do it over 60 minutes (or more). We did it over 30 min. and she did fine.

I would pay the $$ to have a home IV nurse come in and show her how - it's necessary to have the right directions!

We used a great pump that delivered the pump evenly over 30 minutes. I got the info from another Lyme patient here a couple of years ago. I can share the info with you if you want it - just email me.

Lynn LM