We are currently using Midlines for intermittent Vancomycin infusisons that are of a time frame of 2 weeks or less .
We did a little study/data collection to see how well tolerated it would be, because we knew we had seen phlebitis show up frequently with midlines and Vanco . Leadership cited articles regarding use of Midlines for Vanco. Of course their goal was to reduce the utilization of Central LInes in an attempt to reduce the risk of CLABSI. In these articles they all mention the concentration of Vanco of 4mg/ml as the maximum dose. In our data collection we noted that our pharmacy ( HCA division wide ) has several doses of Vanco that ends with a concentration of 5mg/ml. Without surprise we noted that over 50% of pts who received that concentration developed phlebitis.
I meet with pharmacy to see if they can dilute those particular doses more to bring the concentration down to 4mg/ml. I bring our data and the studies regarding the use of Midlines with Vanco and the concentration recommended and they say that no one else is doing that . That i need to do more data collection to see that Vanco is the cause of the phlebitis. i need to see what other facilities are doing.....
I was not pleased with that response. I explained that it is a known fact that Vanco has the potential to be an irritant to veins and cause phlebitis. That is why in the past we used PICC lines. But.......in an attempt to reduce useage of PICCs and reduce risk of clabsi people are doing studies to see if and how it can be given safely in a Midline.
So.......what are you all doing??
Do you have a maximum concentration of Vanco given peripherally?
Are you using midlines for Vanco therapy? any specific criteria for that ?
Anyone have any further studies or information that could help me? I dont understand why it is so difficult to change the dilution of a drug.
thanks, Gina Ward RN, VA-BC