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Administration of irritants and vesicants.

Does anyone work at a hospital that includes in their policies the medictions, by name, that must be given through a central access device? I would appreciate advice on how to right a policy like this. I submitted one several years ago, and it was shot down because of the length of the list. I would like to write a new policy with "must haves". Any help would be appreciated.

I think the idea of a 'must'

I think the idea of a 'must' list is going to be hard to pass. With a 'must' list, if a drug on that list is given without a central line in an emergency the nurse will not be covered by the hospital for any problems that might result. It might be better to make a list of should drugs for central lines, and should never for midlines. We recently got a 'should never' list for midlines, and it is very nice to tell an MD I cannot start a midline for 3 days of vanco - the policy supports me. You also need to look at the availability of persons that can place a central line. A lot of small hospitals would need to call someone in at night, and this will not go over well.

I recently left the hospital, but we were making progress mostly through educating the nurses to request central lines for some of the meds.We also sat down with the pharmacy to see which meds we were giving a lot and chose a list dependent on that - recommending central lines for about a dozen drugs to start with. It made the list very long to put meds on it that we rarely gave, and any long list may be hard to pass. It may be a piece at a time.

Use the INS standards, the idea of the harm that might be caused, and accept any change you get and start planning the next step. It wasn't until the nurses were told that some nurses lost their license after giving vanco through a midline that we got a lot of support for that.

I may not be very organized this am, but I hope that this helps, and good luck.



Gail McCarter, BSN,CRNI

Franklin, NH

Thank you for your reply

Thank you for your reply Gail, I appreciate your advice. I would like to write the policy to cover the emergency use of a drug, and the first 24 hours of doses, but write that a central access should be considered, asap after the order is written. When I worked at Children's Hospital of Philadelphia, the physicians knew that if they ordered Vanco. for a child that it was an automatic order for a PICC within 24 hours. It worked very well. I was thinking along those lines. I know the original list of meds should be small and then build on it as time goes on, that was a good suggestion from you. My husband was a patient here and had a significant infiltration of Levophed and on another admission he had amiodarone infusing peripherally for 4 days. Needless to say he had two pretty nice cords, one in each arm.

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