Our dilemma is presenting doctors with data/information about why irritant medications should infuse through a central line. We have the usual response of "we've been giving vanco for 20 years peripherally, we haven't seen much problems, or there's no evidence that it requires a central line" Some sources will say that vancomycin is an irritant and some will not. They aren't convinced by the list of irritant medications. Pharmacy does not recognize this list and feel their IV meds are peripherally compatible. Apparently the doctors are not seeing the phlebitis, infiltrations, multiple restarts, multiple sticks the patients experience when the veins get damaged with repeated irritant medication infusions, delayed medication administration times, poor venous status on subsequent hospitalizations, etc. Of course, we conveyed to them that we realize there may be comorbidities that would prohibit a central line, and we understand that. What would be a good way to gather/extract/organize the data? Our VAD team is not 24/7 so we cannot do all the tracking.
The key here is that your service was set up to put in catheters, not perform the entire role of an infusion nurse specialist. We have tried for several years to separate vascular access from infusion therapy but it can not be done safely. There is evidence but you must know many additional factors about the drug and infusion outcomes. First, vancomycin is a vesicant, not just an irritant. If there is infiltration, tissue necrosis can and does occur. Do you want to deal with lawsuits due to this problem? Infiltration is the most frequent cause of infusion-related lawsuits. Second, you have to understand the pH of this drug and its impact on venous endothelium. Third, you must have your internal data on the dwell time and complication rates for all PIVs, especially this drug. You can go to my blog to learn more at http://hadawayassociates.blogspot.com/2007/05/changing-physicians-percep.... 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
Thank you, Lynn. I will take this to my coworkers for discussion, it will help us tremendously!
mahalo
If a patient gets phlebitis, infiltration, extravasation write an incident report. If a patient's IV does not last 72-96 hours of dwelll time wirte an incident report. If a patient misses meds or only gets partial meds due to a bad IV from vanco wirte an incident report. After one weeks of reports you will see change occur fast. Risk management will be discussing what is happening
Kathy Kokotis
Bard access