Can anyone share with me how Vancomycin is given at other facilities. We have many inpatients receiving Vancomycin via peripheral IV sites. This is poorly tolerated in many patients and requires sometimes daily site changes due to phlebitis, even though we are hanging this with a flush bag running at the same time for dilution. Pharmacy wants the Vanc to infuse at 120ccs/ hr for therapeutic levels to be reached.
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
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
I have this problem as well.
You could look into instituting the assessment advantage program
you can try to go through the channels to make policy that states this should be run by central line. MDs cannot override policy
working with Pharmacy to capture the patients that are on vanco. --or to take on this challange would be ideal
you must have enough staff to be able to institute this kind of practise change as it will then have to be consistant. Otherwise you would just have to champion for each individual case that you think warrents a PICC or CVC
I have attached a nice example of what Vancomycin can do peripherally in one dose. It took us two years and several extravasations, but we showed the docs every single time we had one, and charted to make them responsible for it. It was amazing how quickly they started asking for PICC's. They sometimes even jump the gun now, and ask for a PICC before culture results are even back. It is a lot of work, but changes can be made, even one patient at a time.
Kristin Walker RN, BSN, OCN Maui Memorial Medical Center IV dept.
This is also a MAJOR problem in our infusion center, but I have a place onthe orders that staes if greater than 3 days of ANY vesicant or irritant a central line will be placed. should I receive an order from a physician that states peripheral, i am on the phone with them discussing the potential problems. Some are reluctant, but others listen. For the ones that do not order a central line, I document the discussion with the physician re: central line placement. Many patients do not want to be "stuck" every three days, but with these medications it is not unusual to be "stuck" every infusion.
Now, in the main hospital setting, I have no control, but I am attempting to set up a Vascular Access Consultant for patients admitted with osteomyletis, MRSA, etc that will require long term antibiotics or other vesciant/irritant drugs.
If the physician refused to listen to the evidence - pH and the studies that show 100% phlebitis rates - then I would refuse to give the drug as ordered, especially through a midline. If you can not place a PICC or the patient refuses to have any type of CVC, I would explain the risk and benefits again to see if they would change their mind. If not, I would only infuse Vancomycin through the smallest gauge peripheral catheter in the largest possible veins, always avoid areas of joint flexion but use a handboard if the hand or wrist is required, never use the antecubital fossa for PIV, ensure proper catheter stabilization with a manufactured stabilization device, ensure that you can always get a blood return from the site before each and every dose and restart the catheter if not. Be sure you tell the patient about the risk of extravasation and the frequency of venipuncture with this method. In my opinion, the patient is the only one who can make the decision to go this route. It is not appropriate for the physician to unilaterally make this decision for the patient. There are risks of tissue necrosis with extravasation. Your responsibility would be to thoroughly document what you did, what you taught the patient, and your thought processes for the decisions you made. If there was a lawsuit, your documentation is the best thing you can produce from the medical record to support that you followed the national standards of practice. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
www.hadawayassociates.com
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