In our outpatient infusion suite we administer a lot of Daptomycin via peripheral/midline catheters. We recently had a midline/picc inservice and the teacher told us we should not be infusing this medication peripherally since the pH is less than 5.0. I asked another local infusion suite what type of lines they infuse this drug through and they use piv/ML catheters. The INS standard reads: “medications with a pH of less than 5 or more than 9 should be infused through a CVAD” . Next I went directly to the pharmaceutical company and they stated that piv or midline was ok to use to infuse their drug. So, do I go by the pharmaceutical company or the INS standards?
Both should be used. In the case of conflicting information such as this, you must assess the sources of that information. I would seek more information from the manufacturer such as what test did you do to assess that your drug with a pH of XX will not produce phlebitis? For the INS standards, the new edition now in the mail will provide you with the exact references from which our statements are based. You should then take this information to your appropriate commitee for review and a decision. You should also have outcome data on your infusions of this drug. What is the rate of complications with it? How long do these peripheral catheters dwell before they must be changed? All of that should be presented to the appropriate committee(s) for a decision. My professional opinion would go with the INS standards because 1) I have read that literature on phlebitis and pH, and 2) most pharmaceutical companies do not perform these types of studies on their individual drugs so may not be able to provide any additional information. 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 so much for your input, it was very helpful in our decision making!
Alyssa