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Extravasation prevention with PIV

I have searched the downloads on this site to help critique our overall practice as it relates to the prevention and management of extravasations.  Lynn, I did read your  Nursing 2004 article "Preventing and managing peripheral extravasation".

More specifically, I am looking for evidence regarding the practice of continuous infusions of vesicants through PIV.  A 2008 article written by a legal nurse consultant stated INS mandates "continuous vesicant infusions should be administered through a central venous catheter".  Now I believe mandates and should be are two different things.  I looked through the Standards and could not find this statement.  I found S55.5 states a prevention plan shall be strongly considered but this is the only thing I see regarding prevention.  I looked under Extravasation section.

Anyways, I have seen patients in our critical care unit have extravasations of dopamine, dobutamine, neo-synephrine through PIVs.  I would like to change our practice but the physician buy-in would require evidence to support the placement of a CVC for therapy that usually is time limited.

Thoughts??? Does your organization make a stand as to how long a continuous vesicant can be administered through a PIV?  Care to share?


Donna Fritz
ONS help

You might get some help from the Oncology Nursing Society.  In their chemo standards (Chemotherapy and Biotherapy Guidelines and Recommendations for Practice, 2009), it states vesicants to be administered for longer than 30-60 min need a CVC.  No wiggle room.  From page 101:

When administering a vesicant drug by short infusion using a peripheral vein:

a.   Avoid using an IV pump in order to decrease pressure on the veings.

b.  Remain with the patient during the infusion.  Visually monitor the site for signs of extravasation while verifying blood return every 5-10 minutes.

c.  Avoid infusion vesicant agents peripherally for more than 30-60 min.

Fortunately, our med oncs are on board with this.  I think many of the drugs you mention are given peripherally and are as much a vesicant as some of the chemotherapy we give.  It seems to have been accepted practice for a long time, e.g. vancomycin, phenergan, etc.  I find pictures can be more convincing . . . or articles that chronicle successful litigation on the part of patients for injuries resulting from drug administration.  If indivudual physicians won't do what is recommended, maybe you will need to go to P&T committee.

INS does not "mandate"

INS does not "mandate" anything. No professional organization has the authority to mandate anything about professional practice. So this is the wrong word applied to this question. You will find statements in either the Site Selection or Catheter Selection standard, not sure which but I know it is there. I do agree that all vesicant infusions require the high level of patient assessement as Angela described from ONS statements. So I think you can apply that guideline to all vesicant infusions. Lynn

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

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

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