One of our ID docs has ordered continuous infusion of Nafcillin at least twice. I know that because one of his patients occluded her PICC within 48 hours (had been discharged on the infusion), came back to the hospital for line replacement and that one occluded in about the same period of time. This week I had an ICU patient with the same scenairio. I dissected that PICC when I removed it and was able to express a white cheesy looking substance, without a doubt it was a drug precipitate. Anyone else? Tips?
Alma Kooistra CRNI
I place PICC's for Nafcillin several times a week and have never seen this. A few questions....
1. Are the infusion nurses using a dedicated line for the Nafcillin or infusing other medications and or fluids through that line? (We almost always place a dual lumen for a Nafcillin infusion)
2. What brand of PICC are you placing. Have you talked to your product rep?
3. Does Cath-flo work on the clots? This may be able to be used a differential diagnosis tool. It would not work on precipitate.
Martha
I place PICC's for Nafcillin several times a week and have never seen this. A few questions....
1. Are the infusion nurses using a dedicated line for the Nafcillin or infusing other medications and or fluids through that line? (We almost always place a dual lumen for a Nafcillin infusion)
2. What brand of PICC are you placing. Have you talked to your product rep?
3. Does Cath-flo work on the clots? This may be able to be used a differential diagnosis tool. It would not work on precipitate.
Martha
If this is a single lumen PICC and a continuous infusion, there should not be an issue unless the nurses are trying to give another drug through this line. There are numerous incompatibilities with nafcillin. Are they using heparin or heparin lock solution for any reason? A continuous infusion would never need heparin lock but some nurses don't understand this. Many pain management drugs are incompatible. Check the monograph for nafcillion in Gahart's Intravenous Medications. They list numerous drugs that cannot be added to the same fluid container and others that are incompatible when given at a Y-site on the IV set infusing the nafcillin. If you are using a dual lumen, drug contact could happen at the catheter tip just as the drugs come in contact with each other. But it sounds like this is happening within the catheter lumen from your description. Have you tried to reverse this precipitate with sodium bicarbonate? Nafcillin has a pH between 6 to 8.5. A drug with a lower pH may have lowered the pH of the nafcillin causing the precipitate. So the bicarb reverses this decrease, driving the pH back up and possibily reversing the precipitate. 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 the infusion rate? I have had issues with sluggish catheter on active patient when the pharmacy uses too slow of a rate (trying to decrease bag volume) in a very active patient!!!