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Gilda Taylor
Internal jugular venous access for the use of vancomycin ? OK

Discussion with MD stating to me that the use of vancomycin via internal jugular vein was OK. I showed him the CDC guidelines of 2002 insertion site of internal  jugular vein high for infection. He said ok with the use of vanco and not ok with TPN. HELP.

windstrings
Its understood by many

Its understood by many facilities that its ok to use vanco for short term use in a peripheral site as many times vanco is given prophylactically after initial surgery or until the definitive word is out as to what the exact bug is they are treating.... then a lesser abx will be chosen that ok peripherally anyway. This normally only takes no more than two days.

The real question is "where is the tip". Is the IJ central?

If not and only a short peripheral, I'm nervous about causing inflammation to any vein that drains the brain.... knowing that complications could be much more devestating than in an arm.

What is the dose of the vanco and how often?

I am not an authority, but my short answer is "no"....I would rather start a peripheral in the arm if possible for short term use.

If it appears to be the drug of choice for a known bug that will require several days of treatment, I think a central line is in order. 

If thats not an option, then an ultrasound assisted IV in the arm is usually pretty managable.

If there are no other viable options... I would be nervous about going more than one day...... others may not be comfortable with even that time frame.

***Remember problems with phlebitis in deep veins is not usually apparent until it is far progressed.

Nurses on the floor usually use a line as long as it works.... which makes an IJ a risky option.

Even an "EJ" which may be more likely to show signs of problems sooner as its more "surface" is still a "brain drain" and I don't like the idea of using jugulars for anything but "nice" drugs. 

The second mouse gets the cheese!

lynncrni
Lynn Hadaway, M.Ed., RN, BC,

Lynn Hadaway, M.Ed., RN, BC, CRNI

www.hadawayassociates.com

Lynn Hadaway, M.Ed., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

lynncrni
Sorry I click the post

Sorry I click the post button too fast. The IJ insertion site is not the problem. The tip location is exactly the problem. Are you talking about an IJ-inserted central venous catheter or an IJ-inserted peripheral catheter? I would refuse to give long term vanco through the latter. Tell the doctor he has to give every infusion and see what happens. Vancomycin pH will always be less than 4 regardless of the dilution. Anything less than 5.5 produces 100% phlebitis in animal studies. This IJ PIV will probably only last for a few doses, so why take the chance. Why is it not possible to insert a CVC? Lynn 

 

Lynn Hadaway, M.Ed., RN, BC, CRNI

www.hadawayassociates.com

Lynn Hadaway, M.Ed., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

afruitloop
Hi Lynn, Could you share the

Hi Lynn,

Could you share the reference for the animal study?  It wouldbe helpful for me.

Thanks,

Cheryl Kelley RN BSN, VA-BC

Gilda Taylor
Insertion site IJ central

Insertion site IJ central placement in SVC.

lynncrni
Then that is perfectly

Then that is perfectly acceptable for vancomycin infusion. If the patient goes home with this site, it might not be the most comfortable but the tip location is what determines what fluids and medications can be infused, not the insertion site for any central venous catheter.  

 

Lynn Hadaway, M.Ed., RN, BC, CRNI

www.hadawayassociates.com

Lynn Hadaway, M.Ed., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

windstrings
 Humm.....maybe you can

 Humm.....maybe you can relate it to something he's more familiar with.... the ph of 40meq of K is about ph of 4.0.... vanco is usually lower than that.... especially if the dose is high.

Most Doctors seem to be sensitive to the effects of 40meq of K+..... even 20meq hurts.... let alone 40meq.... if you can show that Vanco is lower than that, maybe it will get his attention. Simply pick the phone and ask your pharmacy the ph of vanco.

 For short term, many use peripheral sites..... if the IV is in a decent size vein, you usually won't have bad effects within 2 days....much longer than that, you can bank it will take out the vein.

One question is "which vein are you willing to risk?" ..... my vote is almost any besides the neck veins!!!

 

There is enough blood flow in those veins that you may be ok, but its bad form to consider that risk as ok.

I always ask the question.... based on what I know.... is it ok for my mother or dad? 

 

 

______________________________

Always remember that you're unique. Just like everyone else.

The second mouse gets the cheese!

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