Solumedrol infusion speed?

[dilemmantrauma]

My original neurologist, when first diagnosed, wanted 1 gram done over three hours and didn't seem to like that the nurses said that it could be done faster and I had them speed it up to get out sooner after the first few days.

The place it was done the first 3 separate 5 day infusions used a 500ml infusion and an hour or a little more was the fastest.

Today I started another course of it at a different place and it is a 250ml bag and they said they can do it in approximately a half hour.

Basically, my question is if anyone knows if it makes a difference how fast it is done?

It was done over an hour or so today, tomorrow faster most likely.

[Redwings]

Infusion speed depends partly on how much steroid and how large a bag is used, and partly on the "house rules." I've had many 100 or 250 ml bags with 1 gram of Solu-Medrol dripped over a half hour or less. That's comparable to 500 ml dripped over an hour. Some people get nauseous and/or dizzy and can't take that much steroid or that much fluid that quickly, so have to have the infusion spread out over more time.

At my infusion center, the rule is no faster than 1 hour for 1 gram in a 100 to 250 ml bag. When home health was coming out, their rule was no faster than 2 hours for 1 gram in a 500 ml bag. For a patient who tolerates the infusion well, 3 hours is simply torture!

As far as effectivity of the steroids in MS and the like, it doesn't make much difference how fast they go in. Twenty years ago, the steroid protocol for ON from the Optic Neuritis Treatment Trial was 250 mg of Solu-Medrol 4 times per day administered by IV push. That's 250 mg in bit of saline in a regular syringe injected (pushed) directly into the hep-lock (burns like an SOB, by the way!). That takes about 10 seconds. Makes that 3 hour drip look pretty ridiculous!

[LisaL77]

Hi!

I had my infusions at home over a 5 day period. It seemed like a GIANT BAG and a daunting challenge to complete in an hour and 15 minutes. This doesn't sound right but I thought she said it was 2500 cc's of IV fluid.

My visiting nurse said to be VERY hydrated to faciliate the process so I guzzled water before she came, 32 ounces at least. She also used my heating pad to warm the area she wanted to insert the IV port before insertion. She was right, being fully hydrated did make it easier and faster.

I did NOT care if the accelerated speed made me dizzy, nauseous, experience a stinging sensation in the arm with the IV, etc. I wanted it OVER with, LOL. I was falling asleep before the nurse even left.

If they offer to accelerate the process and you aren't squeamish about the side effects, then go for it. Your personal time is valuable.

[dilemmantrauma]

I talked to a friend/nurse that worked in a neuro unit for a while and is an er nurse now. She thought that sounded pretty fast based on how they do it where she works. Mainly because of the risk of heart attack or arrhythmia. They also monitor vitals and do blood tests every day a 5 day course of steroids.

I think I'll just stick to the hour or a little longer and not speed it up just in case.

[jbell2435]

interesting topic!

My first round in Dec used 1 gram balls and it took about 1 1/2 hrs each time, the this time (last week) it was a smaller ball, so I thought I was getting less steroid, nurse explained it is just less saline! This last dose didn't leave as bad of the metallic taste and went a bit faster, about 1 hr.

[dilemmantrauma]

I notice I didn't get the metallic taste as well with less saline.

[skreynolds57]

One gram in one hour is the right rate. Too much too quickly is not good. Without giving a long story, you may not want to drag it out for several hours, but too short is not the direction to err.

[maitrimama]

small veins

Thank goodness it has been a while since I have had IV steriods or antibiotics but I have been told that my veins are very small so they use pediatrics needles and have to go slow. More than once a vein has become "hard" and they have had to move the IV - ouch!

[FL_Jhawk]

I do 1 g in 30 minutes. We tried it slower but I tolerate this faster rate pretty well with no effects. You can ask them to speed it up gradually to see how you react. No use spending more time sitting there than necessary, IMHO.

[BigA]

I had my drip on 1gm in one hour and they always asked me if I wanted it in 30 minutes. I figured they were asking so that they could get one more patient done that much faster.

Since I had no idea, but didn't have the best impression of them, I went with what seemed standard procedure, so 1 hour.

[MarkLavelle]

I have been told that my veins are very small so they use pediatrics needles and have to go slow.

My veins are tiny and they run & hide when needles approach. I average 2-3 sticks every time I get a blood test or gadolinium.

My first day of chemo (back in '96) the nurse told me I needed to get a port. Since I stubbornly had to go and survive and all that, the port was taken out after a while (they crust up inside without maintence).

[maitrimama]

Mark - I am willing to bet that your veins are also like mine in that that they are deep and they "roll" whenever anybody gets close! One tech thought she was smart and went for the back of my hand only to find a valve everywhere she tried to stick!

[KateA2]

I've had steroids 3 times, and if it was a longer series (3-5 days/1gm per day) it took 1 1/2 hours for 1 gm. with full saline bag as it burned so badly I couldn't stand it at a faster rate...I also found the IV location mattered: inner arm much easier than hand or wrist.

[LisaL77]

Goodness, I was unaware of the risk of too fast IV drip. Avoid the risk and wait it out. WOW!

They didn't explain that to me, they just told me how fabulous my vitals were.

[dilemmantrauma]

The risk of heart attack is in the first 10 minutes is what the books said according to my nurse yesterday. It must be a very rare reaction.

250ml/1g solumedrol instead of 500ml/1g has equaled none of the metallic taste and none of the crazy water retention.

That is definitely worth pointing out to your doctor/nurse. My other courses have been 500ml/1g and I always retained a ton of fluid and had the metallic taste.