I know this is an unresolved topic from the past, but we have a physician ordering daily venipuncture for IV ABX in our Infusion center for a known IV drug abuser. The patient is self pay so will not be accepted by any SNF or home care company. Expense of 6 more weeks of hospitalization is a consideration. The MD will not allow insertion of midline or PICC, or even allow the PIV to stay in place after ABX administration due to the high possibility of misuse by the patient. He is already a very difficult stick. Is there any best practice information available for this situation? This patient will not have peripheral access for daily sticks for 6 weeks. Any information would be much appreciated. Chris Duchene BSN, RN
If there is no alternative with the MD, ask to have this done at the MD's office and his staff if possible. Or have the MD provide funding for an Ultrasound. (Check out the rental of the new Philips Lumify and send the bill to the MD). Use vapocoolant spray and other pain reducing measures along with the 24 or 22 ga catheter. Can you use a phlebotomy needle and syringe to IVPush the meds? Ask the patient where his best veins are that he has not used yet. Notify your manager, VP and risk management office of the situation. Let us know how it all worked for you. Best of luck.
Scott Gilbert, RN MPH (Honolulu)
Have you considered the use of either Orbactiv or Dalbavance as an alternative? For our IV drug user patients we realize we may not be able to get optimum care, but these two medications will cover the patient for two weeks. Sometimes some treatment has to be better than none.
Barbara Tinsley