My facility starts a large number of patients on IV Vancomycin using periperal IV sites until culture results are back and a determination is made to continue the Vanco or switch to another drug. We run about 50% remaining on the Vanco. My problem is that even with 2 or 3 days of Vanco, the PIV is likely to become sore and need to be changed, yet the docs aren't willing to order a PICC until they know if the patient will be on the Vanco for an extended period. To complicate matters, our new ID doc wants 48 hours of negative blood cultures prior to allowing a PICC to be placed, often extending the PIV Vanco infusion to a week and several angry sites.
How are others dealing with this issue?