We have been placinig Midlines in many Covid positive or PUI . This helps with secure access and also the nurses having to obtain blood for the lab.
What we have found is the pts who are receiving the Remdesivir are having some phlebitis rather quickly . Upon looking the Remdesivir up I find the PH to be listed as 3-4 . Typically that would warrant a PICC line. The current regime is 5 days of therapy with one dose a day.
What kind of experience are you having with this? Are you placing PICC lines on these pts?
Thanks in advance, Gina
pH alone is not the only deciding factor for choice of a peripheral vs a central VAD. Look at osmolarity and many other factors to make this determination.
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
I had much difficulty finding the osmolality of the drug. My pharmacists did not have any info. I called the Gilead Sciences who put out the info for the EUA.
Osmolality varies with dose and total volumes; PH ranges from 3.97-4.11 and osmolality ranges from 330-550
100mg/100ml ph 3.97 osm 400
100mg /250m ph 4.11 osm 330
200mg/100ml ph 4.07 osm 550
200mg.250ml ph 3.99 osm 380
We are finding the pts are getting multiple fluids and meds; some combinations of Vancomycin, Zithromycin, Maxipime in addition to the REmdesivir so I am not sure the Remdesivir is causing the phlebitis but.....I wanted to explore the characteristics of drug to help us make our decisions.
We had 2 out of 3 pts develp phlebitis in their midline aft 1-2 days. I also am aware that the Zithromycin and Vancomycin could also be contributing factors.
The initial reason for the consult is poor venous access; the staff are having difficulty starting or keeping ivs, and then also difficulty obtaining blood for the lab ( as the nurses are having to draw their own blood on these pts too).
I was wondering what everyone elses experience with the drug is. We are just starting to get the COVID positive patients in our facility.
Gina Ward R.N., VA-BC
all those drugs are far too much to expect a midline to be complication free through the entire course of therapy. The last thing you need to be doing are multiple VAD insertions on Covid patients- inserter exposures, wasted PPE, in addition to wasting patient veins. For all those drugs, a PICC or other cvad is needed. IJ sites also increase exposure to inserter due to close proximity to respiration's of patient. So PICC not midline
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Thank you very much for your input.
Gina
Gina Ward R.N., VA-BC
To answer your question Gina,
we to have been placing Midlines for Covid pt's since the begining. We have seen that these pt's are often difficult to maintain IV access and have poor vasculature. We had a situation were a pt crashed with no access so the cheif Hospitalist annonced that every Covid pt should get a Midline from now on. The PICC team has been able to walk that back by offering to place more secure PIV's for these pt's which has seemed to satisfy the MD's & the nursing staff (sometimes). The pt's that we do place Midlines for are often a single lumen unless they are on a Vent, then those pt's may get a Dual lumen. I spoke with our pharmacist & several of the nurses; charge, staff & one of the managers, they all agreed that they have had no problems with any of the pt's that have had Midlines & they seem to be in Love with the Midlines. The PICC team had not heard of any problem with any of the Covid pt's Midlines. The pharmacist mentioned one pt that developed Phlebits & the Midline was D/C, and only one other Midline was D/C D/T that i could find out. The second pt. developed a + blood culture & the MD had everything D/C from the pt including the Midline.
Thanks for the info on Remdesvir: We are infusing 200mg/250ml over one hr daily for the first dose then 100mg/250ml over an hr. daily. The pharacist reported that some of the nurses expressed concern about the rate.
Timothy McCrory, RN, BSN, CCRN, VA-BC
I most likley would be advocating for a PICC or other type of CVAD with this many therapies prescribed. They have discovered that many Covid -19 patients have increased levels of Factor V . This puts them at an increased risk for DVT and PE. There is still so much we do not know but it is something that should be considered when selecting the most appopriate VAD.