Strategies to administer IV infusion medications

For example, you can dilute many IV push antibiotics with 10 mL of sterile water, but use 20 mL for 1 g doses of meropenem...

As a hospital pharmacist, you should help your hospital think outside the box to further conserve large- and small-volume IV fluids during shortages. Create alternative ways to prep and administer IV infusion medications. Many hospitals are switching to IV push. Help ensure a safe transition...

Use sterile water to dilute IV push medications when possible. Using D5W or normal saline instead of sterile water, or not diluting enough can increase osmolarity and extravasation risk. For example, you can dilute many IV push antibiotics with 10 mL of sterile water, but use 20 mL for 1 g doses of meropenem. For medications that shouldn't be pushed, consider alternatives, such as IV push cefepime (Maxipime) instead of piperacillin/tazobactam (Tazocin, Pipra-Taz) for Pseudomonas. Save antibiotic continuous infusions in large-volume fluids as a last resort, due to limited data and IV incompatibility issues. But be prepared by approving protocols now. For example, consider a vancomycin 15 to 20 mg/kg load, then 30 mg/kg continuous infusion over 24 hours in patients with normal renal function.

Evaluate if high-alert medications can be infused through a syringe pump instead of large-volume infusions. For example, consider prepping insulin drips in 50 mL syringes instead of 500 mL bags. Label syringes carefully to help avoid accidental IV push. Save large-volume fluids in short supply. Work with your hospital to allow automatic switches to alternative IV fluids, such as D5W with 0.225% sodium chloride (D5 1/4NS) in place of D5W. Stop continuous infusions in patients with orders to "keep vein open" or "KVO." Instead, switch to catheter locks or flushes. And limit large-volume IV fluids in short supply to certain indications, such as saving normal saline boluses for septic patients. Limit IV medication use when possible. Ensure your hospital is maximizing automatic IV to PO switches, shorter IV antibiotic durations, etc.

References

Shortage of Small-Volume Parenteral Solutions Hits Hard - ASHP. [online] Available at: https://www.ashp.org/news/2017/12/08/shortage-of-small-volume-parenteral-solutions-hits-hard‌.
Intravenous Solution Conservation Strategies (Compiled by the American Society of Health-System Pharmacists and the University of Utah Drug Information Service, March 20, 2014) - ASHP. Available at: https://www.ashp.org/-/media/assets/drug-shortages/docs/drug-resources-conservation-strategies-iv-fluids.ashx.