title: Using higher doses to compensate for tubing residuals in extended-infusion piperacillin-tazobactam.
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.
  
  
  METHODS
  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.
  
  
  METHODS
  All articles that involved extended-infusion piperacillin-tazobactam implementation strategies were included in the review.
  
  
  RESULTS
  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.
authors.affiliation: Rutgers University Ernest Mario School of Pharmacy, Piscataway, NJ, USA. Wendy.Jung@gmail.com
authors.forename: Wendy J
authors.initials: WJ
authors.lastname: Lam
authors.forename: Tanaya
authors.initials: T
authors.lastname: Bhowmick
authors.forename: Alan
authors.initials: A
authors.lastname: Gross
authors.forename: Trevor C
authors.initials: TC
authors.lastname: Vanschooneveld
authors.forename: Melvin P
authors.initials: MP
authors.lastname: Weinstein
mesh_terms: D000818:Animals; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D006801:Humans; D007260:Infusion Pumps; D007262:Infusions, Intravenous; D010397:Penicillanic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives*; D010878:Piperacillin / Q000008:administration & dosage; D000077725:Piperacillin, Tazobactam Drug Combination; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents; D000077725:Piperacillin, Tazobactam Drug Combination; D010397:Penicillanic Acid; D010878:Piperacillin