My facility starts a large number of patients on IV Vancomycin using periperal IV sites until culture results are back and a determination is made to continue the Vanco or switch to another drug. We run about 50% remaining on the Vanco. My problem is that even with 2 or 3 days of Vanco, the PIV is likely to become sore and need to be changed, yet the docs aren't willing to order a PICC until they know if the patient will be on the Vanco for an extended period. To complicate matters, our new ID doc wants 48 hours of negative blood cultures prior to allowing a PICC to be placed, often extending the PIV Vanco infusion to a week and several angry sites.
How are others dealing with this issue?
I can actually understand their reason for not wanting a PICC until the complete diagnosis is made. This now means it is nursing responsibility to follow the standards precisely to reduce the risk of complications. That includes
1. always use the smallest gauge catheter - nothing larger than a 24 g for peripheral vanco
2. never use a vein in an area of joint flexion - ever, not ever. No hand, wrist or antecubital sites! Much higher rates of complications in these areas.
3. use a catheter stablization device to ensure that the catheter does not move
4. always aspirate for a blood return from all peripheral site before you start the dose infusion. If not present, do not use that site.
5. do not infusion on a pump because the pump will keep on pumping regardless of where the fluid is flowing. Gravity will slow down if the catheter has erroded through the vessel. A pump will not.
6. adequate dilution of the vanco
Here is some additional evidence to use:
1. Roszell S, Jones C. Intravenous Administration Issues: A Comparison of Intravenous Insertions and Complications in Vancomycin Versus Other Antibiotics. Journal of Infusion Nursing. 2010;33(2):112.
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
What is your thoughts about giving Vancomycin through a midline? We have had a few patients that the hospital has not been able to insert a PICC line and patient ends up with a midline and MD orders Vancomycin at home via the midline.
Carole Rumsey, RN, CRNI
Home Infusion Program Manager
Sutter Infusion and Pharmacy Services
Sutter Care at Home
Northern CA
[email protected]
Vancomycin is not acceptable for infusion through a midline. The pH will always be less than 4 and it is a vesicant. Extravasation injury would be much worse than a peripheral site because the midline catheter tip is deeper in the tissue. It is quite possible for excessive fluid to escape into SC tissue long before it would be recognized. Larger nerves and arteries could be damaged. So Vancomycin should be infused through a PICC or short peripheral for a few doses until the full treatment plan is formulated. See INS standards. 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