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Kevin Travis Flint
IV Cardene and rotating/changing PIV q 12 hrs

Please offer your thoughts on changing PIV site q 12 hrs with IV cardene, read the following response from an educator:

spoke with the medical information pharmacist who works for EKR Therapeutics (Cardene) and our drug rep.  He sent me info on Cardene and phlebitis if you are interested.  The incidence is low.  It is stated in the Cardene insert info to rotate/change sites every 12 hours.  This is nothing new.  He is not aware of any INS guidelines that state Cardene requires a PICC or central line.  If this is new and changed he has requested I let him know where specifically this information can be found.   If it is a generality that any irritant should be given through a Central Line or PICC – that does not warrant an absolute that patients on Cardene should have one, only that if they have one then we should use those lines to give Cardene through to be more beneficial to the patient. 


I think the IV therapy staff and nurses need to be aware that patients who are on Cardene drips that have a peripheral line will need a new peripheral IV in 12 hours.  The one the Cardene is currently infusing through can be made into a saline lock if the site is without complications, and a new site started.  Then if the patient is to continue on Cardene for another 12 hours after the new line is place they can go back to the old site (rotate site).  This is what is being done in many hospitals.

The Cardene rep will be glad to come and do an inservice for the IV staff on this if necessary.


Attached is the info the pharmacist from EKR Therapeutics sent me.

I hope this helps, contact me if you have other questions and issues.  Also, please let me know if you have specifics on the INS guidelines.


Gwen Irwin
I don't see the

I don't see the attachment.

Gwen Irwin 

Kevin Travis Flint
The response from the
The response from the critical care educator typed out under my opening sentence
To adhere to the INS

To adhere to the INS standards of practice, you must know the final pH and osmolarity of the solution and also if it is a vesicant. pH above 9 or below 5, osmolarity greater than 600 and all vesicants should be infused through a CVC. So get your pharmacists to provide this information to you so you can make a valid decision. 


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

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

Heather Nichols
   The extravasations of

   The extravasations of Cardene are few, but they are usually bad.  It comes out to a pH of less than 4 at a regular IV dose, and the strengthened dose is even lower.  The print out from the company themselves cautions "Avoid Extravasation", not infiltration, so that suggests to me that they see their drug as a vesicant, not an irritant.  It also states to rotate the PIV every 12 hours which could easily add up to the cost of a PICC, not to mention the pain to the patient, and addedd stress to the nurse as well as extreme injury to your patient.  Why take that chance.  If the company knows it is dangerous, that should be enough recommendation for central access of some kind for your patient.  Not to mention that if the patient is on Cardene he/she is unstable as it is, and should have a more dedicated access than a PIV.  We changed this some time ago at our institution.  ONS has very specific guidelines for the continuous infusion of vesicants.  So does INS.  You should probably print these things, and the manufacuturer information, and present it with the costs to.  Good luck.  It has been a long battle here to.


Kevin Travis Flint
thanks to all
thanks to all
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