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Thu, 03/29/2007 - 19:09

Jerrbear

Temporary access for a renal patient on Vancomycin

I have a 57 yo male patient with a history of two kidney transplants.Â He was transferred to us from Montana, on Vancomycin for MRSA.Â He has a small peripheral catheter in his hand.Â I know that the dialysis folks would prefer that we never put a line in a vein that may someday be needed for dialysis.Â So what is the alternative?Â This guy had a PICC line placed at another facility two months ago, but itÂ was removed February 20.Â I think that we would do him less harm with a PICC line than a number of small peripheral sites.Â Do you go to the IJ on these folks, or would he benefit from an implanted port?

I just want to know what the thinking is.

Fri, 03/30/2007 - 15:28

lynncrni

According to the NKF DOQI

According to the NKF DOQI Guidelines, a catheter that crosses the subclavian vein should not be used in patients that have impending or are in renal failure. If your patients kidneys are functioning well, then dialysis is not on the horizon. Where is his infection? I would discuss this with the nephrologist and make a collaborative decision about the best choice for this patient. If this infection could become a chronic need for IV ABX, then an implanted port could be the answer. Without knowing more details it is hard to recommend one vs the other. Lynn

Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Mon, 04/02/2007 - 01:41

Nadine Nakazawa

I doubt the nephrologist

I doubt the nephrologist would want an implanted port for a patient with an infection requiring Vanco. They would prefer a PICC in the dominant arm, assuming that the non-dominant arm already has a functioning AV fistula (for past and potential future use), or leave the non-dominant arm for a future fistula. Or they may prefer a "small bore tunneled catheter" placed in the IJ, tunneled a short distance on the chest (like 2 cms). Small bore---5 or 6 Fr. I definitely would only use a peripheral vein until a PICC or SBCC gets placed. Discuss options with the nephrologist for their preference.

Nadine Nakazawa, RN, BS, VA-BC

Mon, 04/02/2007 - 22:20

Jerrbear

Thanks so much for your

Thanks so much for your help. They hadn't really pinned down what was ailing this guy when we got him. He had a history of MRSA, so they started him on Vanco pending the cultures. Turned out he had a pneumonia that was sensitive to Ciprofloxacin, so he got put on pills and we stopped hammering his veins with the Vanco.

Jerry Bartholomew RN, BSN, CRNI

VA Medical Center, Spokane, WA

Jerry Bartholomew RN, MSN, CRNI

VA Medical Center, Spokane, WA

Wed, 04/04/2007 - 13:49

(Reply to #4) #5

KPater

We run into this sort of

We run into this sort of problem quite often, just yesterday as a matter of fact. Lately, the solution has been (after discussion with renal and ID) to have the vanco ran through the dialysis catheter immediately following dialysis. It won't always be the answer, but maybe another option to explore.

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