Mag. Sulfate for suspected eclampsia

cruiseforever

cruiseforever

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Our system has added a suspected eclampsia protocol. We are suppose to give 4 gms of Mag Sulfate over 10 minutes. Just wondering if anyone here has experience in doing this without using a pump? I have been testing different IV sizes with 250 and 500 cc bags along with different drip chambers to come up with a combination that will give us the 4 gms over 10 minutes. Any guidance would be appreciated.
 
Carlos Danger

Carlos Danger

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Do you mean a patient who is actively seizing, or who is pre-eclamptic?

I very frequently give magnesium in the OR, usually 2 or 3 grams in a 1gm/2ml concentration. I usually draw it up into a 10cc syringe, attach the syringe to a luer port, and push a CC or two every couple of minutes. I go slower is the BP is soft, a little quicker if the BP is higher. If the IVF is flowing briskly, often the syringe will fill with IVF between pushes so it's always full, so after a handful of pushes - 10 minutes or so - I know the concentration of mag in the syringe is very low so I'll push the whole 10cc and then remove the syringe.

Alternatively, if the bag of IVF only has a couple hundred CC's left in it, I'll just squirt the mag into the bag. I'm not only of those people who adds a bunch of antibiotics, decadron, lidocaine, and what have you to my full bag of fluid because I just don't think that's a great practice, but if the bag is almost empty and I'm going to replace it in a few minutes anyway, sure.

This is the method I use to give pretty much any drug that you don't want to push quickly, but won't take long enough to give that you have to bother with a pump.
 
Z

zacdav89

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Is 250ml and 500ml the only bags you have access to? At those volumes you'll basicly run the iv WO to get the admin done in 10 mins. If you have access a 50ml bag would be a smaller volume and be easier set up as a drip on a standard set
 
CALEMT

CALEMT

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A 50cc bag with a 60 dropper will give you a 10 minute drip.
 
S

StCEMT

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I have a pump and 50ml bag. I have ran the 50 with a 60 drop set in a pinch before.
 
Carlos Danger

Carlos Danger

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Without a pump, it is going to be impossible to get any specific volume in over a specific time. There are just too many variables that affect flow rate. And counting drips is ridiculous.

Seriously, if you aren't going to use a pump, just put it in a syringe and push it slow the way I described above. You have at least as much control that way as you do putting it in a 50ml or 100ml bag and hoping that it goes in over exactly 10 min.
 
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DesertMedic66

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Our county ideally wants our drips to be in a
CALEMT said:
A 50cc bag with a 60 dropper will give you a 10 minute drip.
Click to expand...
Well yeah, but I’m not a huge fan of trying to count 5 drops per second when you could use a 10 dropper set and only have 1 drop per second.
 
Tigger

Tigger

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50ml bag with a 10 drop set, one a second which is fairly easy to eyeball. Our pumps are miserable so I usually end up doing it by gravity :/.
 
S

StCEMT

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Tigger said:
50ml bag with a 10 drop set, one a second which is fairly easy to eyeball. Our pumps are miserable so I usually end up doing it by gravity :/.
Click to expand...
If you are interested in pitching a new pump, we carry these little Bodyguard 131's. Small and easy to set up. I've used it many times and never had any issues with it. You can teach someone to set basic programs in about 5 minutes.
 
Tigger

Tigger

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Fortunately we just got some new ones delivered. Couldn't afford bodyguards but I'm hoping that our new Sigma Spectrums will work better.
 
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johnrsemt

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use a syringe (10mL flush, or fill a 10mL syringe with it and NS out of tubing) and a 3 way Stopcock. push 1ml every minute out of syringe and turn it off with the stopcock. 1mL/minute over 10 minutes = 10mL.
 
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jwk

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Remi said:
Do you mean a patient who is actively seizing, or who is pre-eclamptic?

I very frequently give magnesium in the OR, usually 2 or 3 grams in a 1gm/2ml concentration. I usually draw it up into a 10cc syringe, attach the syringe to a luer port, and push a CC or two every couple of minutes. I go slower is the BP is soft, a little quicker if the BP is higher. If the IVF is flowing briskly, often the syringe will fill with IVF between pushes so it's always full, so after a handful of pushes - 10 minutes or so - I know the concentration of mag in the syringe is very low so I'll push the whole 10cc and then remove the syringe.

Alternatively, if the bag of IVF only has a couple hundred CC's left in it, I'll just squirt the mag into the bag. I'm not only of those people who adds a bunch of antibiotics, decadron, lidocaine, and what have you to my full bag of fluid because I just don't think that's a great practice, but if the bag is almost empty and I'm going to replace it in a few minutes anyway, sure.

This is the method I use to give pretty much any drug that you don't want to push quickly, but won't take long enough to give that you have to bother with a pump.
Click to expand...
Ah, the joys of doing it "the anesthesia way". We don't need no stinkin pumps!
 
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