Never seen such a list and don't think that is the best approach. Such a list could easily become the "rules" when it was not intended that way. Even though the pH of some drugs like vancomycin is very low, it may be acceptable to infuse thruogh a midline in some patients. Also, the pH and osmolarity are not the only factors that should be considered as those may not be the factors that causes a specific fluid or med to be a vesicant or have phlebotogenic properties. Thorough patient assessment by knolwedgeable infusion nurse weighing all risk and benefits for each patient - the best approach IMHO. Lynn
Is it still advised to infused therapies appropriate for peripheral infusion? With the increased use of midlines, are there therapies that are being found to infuse through a midline with less complications that a short peripheral?
Yes, that is what is stated in INS 2016 Standards. Midline can infuse the same infusates as what can be tolerated by a peripheral vein. I have never seen a study comparing outcomes of midlines to PIV. Lynn
To answer the original question for JHallowell, there is now a list of drugs, published by INS in regards to non-cytotoxic vesicants and irritants. The scope of work was limited to creating an evidence-based list of noncytotoxic vesicant medications/solutions and developing an extravasation checklist that outlines risk reduction strategies including early recognition of signs and symptoms of extravasation.
Both documents, along with a summary of work are available in the INS Learning Centre at their website..
You can find the reference here: Gorski, L. A., Stranz, M., Cook, L. S., Joseph, J. M., Kokotis, K., Sabatino-Holmes, P., & Van Gosen, L. (2017). Development of an Evidence-Based List of Noncytotoxic Vesicant Medications and Solutions. Journal of Infusion Nursing, 40(1), 26-40.
Never seen such a list and don't think that is the best approach. Such a list could easily become the "rules" when it was not intended that way. Even though the pH of some drugs like vancomycin is very low, it may be acceptable to infuse thruogh a midline in some patients. Also, the pH and osmolarity are not the only factors that should be considered as those may not be the factors that causes a specific fluid or med to be a vesicant or have phlebotogenic properties. Thorough patient assessment by knolwedgeable infusion nurse weighing all risk and benefits for each patient - the best approach IMHO. 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
Is it still advised to infused therapies appropriate for peripheral infusion? With the increased use of midlines, are there therapies that are being found to infuse through a midline with less complications that a short peripheral?
Deb
Yes, that is what is stated in INS 2016 Standards. Midline can infuse the same infusates as what can be tolerated by a peripheral vein. I have never seen a study comparing outcomes of midlines to PIV. 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
It still seems like there should be a list of what is okay and what is not.
John Hallowell, PA-C, MBA
It is just not that simple as there are many factors - patient, therapy, venue of care, and VAD - that must be considered. 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
To answer the original question for JHallowell, there is now a list of drugs, published by INS in regards to non-cytotoxic vesicants and irritants. The scope of work was limited to creating an evidence-based list of noncytotoxic vesicant medications/solutions and developing an extravasation checklist that outlines risk reduction strategies including early recognition of signs and symptoms of extravasation.
Both documents, along with a summary of work are available in the INS Learning Centre at their website..
You can find the reference here:
Gorski, L. A., Stranz, M., Cook, L. S., Joseph, J. M., Kokotis, K., Sabatino-Holmes, P., & Van Gosen, L. (2017). Development of an Evidence-Based List of Noncytotoxic Vesicant Medications and Solutions. Journal of Infusion Nursing, 40(1), 26-40.
https://www.learningcenter.ins1.org/products/noncytotoxic-vesicant-medic...
Timothy R. Spencer, RN, APN, DipAppSci, BH, ICU Cert, VA-BC™
That CVC guy from Australia :-}