1017. Residual Infusion Performance Evaluation (RIPE): A Single-Center Evaluation of Residual Volume Post-Intravenous Eravacycline Infusion


 
 
 Intravenous (IV) fluid manufacturers report an acceptable volume of overfill range for a 250 mL bag of normal saline from 265-285 mL. This overfill can contribute to residual drug that is not administered to patients. Frequent instances of incomplete eravacycline infusions were noticed by infectious disease providers.
 Residual Eravacycline Volume Following IV Infusion
 
 
 
 This single-center, retrospective, quasi-experimental study evaluated residual volume after the completion of IV eravacycline infusion in patients admitted during the pre-intervention period (July 1 – 30, 2021) vs. post-intervention period (November 1 – 30, 2021). The intervention (August 1 – October 31, 2021), consisted of updating drug labels to add the drug diluent to total volume and a comment in the administration section to “infuse at current rate until bag is empty.” Nursing education was provided to encourage administration of the entire drug volume. The primary outcome compared residual antibiotic volume before and after implementation of the intervention. The secondary outcomes evaluated amount of drug lost (total mg and percent of total dose) in the pre- and post-intervention periods and cost of facility drug waste.
 Nursing Education Distributed During Intervention Period
 
 
 
 There was an average residual volume of 38.0 mL (range 6 – 85 mL) for pre-intervention (n=9, total of 46 doses) vs. 12.2 mL (range 0 – 37 mL) for the post-intervention (n=7, total of 21 doses) population (p< 0.0001). Residual volume accounted for an average of 15.2% of the total bag volume compared to 4.7% for the pre- and post-intervention groups, respectively (p< 0.0001). The pre-intervention residual volume contained an average of 13.5 mg (15.3% of total dose) of eravacycline, versus 4.7 mg (4.7% of total dose) in the post-intervention (p< 0.0001). Cost analysis used average wholesale price for 50 mg vials. Residual volume in the pre-intervention period estimated $893.45 ($10,721.40 annualized) vs. $161.04 ($1,932.48 annualized) in the post-intervention period.
 Pre- and Post-Intervention Comparison
 Clinical Analysis of Residual Antibiotic Volume
 Facility Waste
 
 
 
 Average residual volume and amount of discarded drug was significantly reduced after the interventions. Following the results of this study, interventions were expanded to all admixed antimicrobials. Further studies are needed to determine the potential clinical impact when patients do not receive the complete antibiotic infusion due to residual volume.
 
 
 
 Kerry O. Cleveland, MD, AbbVie: Honoraria|Cumberland: Honoraria|Merck: Honoraria|Pfizer: Honoraria Michael S. Gelfand, MD, AbbVie: Expert Testimony|La Jolla: Expert Testimony.
