Hello,
Looking for evidence for/against peripheral infusion of vasopressors. INS recommends infusion through a central line but there is some other limited research out there supporting peripheral infusion and physicians are jumping on this to NOT have to place central lines.
Thank you for your thoughts, reference links, etc.!
Trish Hayes, BSN, RN
Can you always guarantee that NO sites in an area of joint flexion will be used? Can you guarantee that frequent site assessment including blood return will be checked and documented? Recommendations for vesicant infusion is every 5 to 10 mLs for this assessment. Do you have a well written policy and procedure for immediate access and use of a protocol to treat an extravasation with an appropriate antidote? This should be within an hour of the extrasavation event. How long will it take to get an LIP order and then obtain the drug from the pharmacy. Regitine is the drug with the most data as an antidote for vasopressors but that drug is in sporadic short supply. You need an interprofessional group to assess your situation and make a decision. I realize the concern over CLABSI and the loss of revenue when it happens, but it can be prevented with appropriate nursing care. Right now, there is no loss of revenue from a nasty extravasation event, but there is the great possibiity of necrotic ulcer, and the need for fasciotomy, debridement and months of recovery for the patient. This can easily produce lifelong nerve damage also. You will hear that these expenses are paid by the insurance, after all that is why liability insurance if present, right?!? I have been an expert on many lawsuits involving these drugs and the common themes are sites in the hand, wrist or ACF, no use of armboards, and absence of any documented site assessment. So the pump keeps pumping the vesicant into the tissue because no one is doing a thorough site assessment and no infusion pump can detect where the fluid is going! 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
I still "vote" for a central line for vasopressors!!!!!
Valorie Dunn,BSN, RN, CRNI, PLNC
What about vasopressors via Midline?
There is no published evidence for or against these meds through a midline catheter. Most of these drugs are vesicants. A midline tip location is located deep in the tissue, where a larger quantity can escape before you would see any clinical signs or symptoms. There are large arteries and nerves in this area. Based on these issuess, I would NOT even consider this. Midlines are approprite for many types of fluids and medications but vesicant vasopressors are not in that group. 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