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Gina Ward
Remdesivir infusion

 

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

 

 

lynncrni
pH alone is not the only

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., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Gina Ward
 

 

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

lynncrni
all those drugs are far too

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., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Gina Ward
Thank you very much for your

Thank you very much for your input.

Gina

Gina Ward R.N., VA-BC

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