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PH of solutions

 I am wondering how other institutions are handling INS guideline in reference to PH of IV solutions that are appropriate for a peripheral infusion. The statement that any solution with a PH less then 5 or greater then 9 is inappropriate for peripheral infusion covers so many solutions. I totally understand for solutions that are very harsh like phenergan, vancomycin or dopamine but D5.45 with 20meq of K+ also has a PH of less then 5. I don't believe these guidelines are followed strictly or almost every patient would require a central line. Please share how your institution handles this issue. Do you have a list of infusions that cannot be given peripherally, and if so do your physicians adhere to the list. Can you share the list? We have just introduced a new Midline catheter at my facility and this has sparked much discussion on this topic between bedside nursing, pharmacy and physicians.

Even though we insert and

Even though we insert and perform dressing changes like we do PICC lines, a midline is a longer peripheral catheter.  It is used for the same medications that are safe for a short peripheral catheter but can remain in place for up to 4 weeks.  Not to be confused with a PICC line we need to be infusing those out of range PH and osmolarity medications in.  Here is a web site a nurse posted on this site some time back.  It has helped me.

C:\Users\057625\Desktop\infusion stuff\List of Irritant and Vesicant Medications.mht

Valorie Dunn, BSN, RN, CRNI

Valorie Dunn,BSN, RN, CRNI, PLNC

Thanks for your response.

Thanks for your response. I am aware that a midline is an longer peripheral catheter and the guidelines for infusion are the same as any other peripheral catheter. I guess the real question is how strictly does your facility follow the INS guidlines since there are so many commonly given solutions that fall just beyond those recommendations...such as D5.45 with 20 of KCL which has a PH of 4.2. Would that warrant a PICC line in your facility? Also, I was unable to access the website you listed. Thank you!!   

 Jaime Jenkins 

Jamie,  Our hospitals do not

Jamie,  Our hospitals do not follow the guidelines very closely.  I am not sure if it ia a lack of education??  I have physicians trying to send patients home on Vanc. with PIVs and I refuse to do that in the home.  I insist on a PICC.  I am currently working on forming an infusion team to decrease/eliminate multiple complications I know our patients encounter.  Wish me luck.  Valorie


Valorie Dunn,BSN, RN, CRNI, PLNC

 Here's a list of commonly

 Here's a list of commonly used irritants and vesicants...


Kevin Arnold RN, MSN

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