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 I have never seen a Venofer infiltration in clinical practice or had a legal case involving this drug. Gahart's Intravenous Medications does not include any information about it being a vesicant. A pH that high in combination with such hyper-osmolarity could cause tissue damage. pH would cause cell death. Hyperosmolarity would cause severe osmotic fluid shifting and could lead to compartment syndrome. Based on small studies in healthy volunteers showing how hyperosmolar fluids dramtically increase the interstitial fluid volume, I would never apply heat to such an infiltration. Heat has been shown to increase the interstial fluid with hyperosmolar fluids. Lynn

 It looks like this is one of those drugs where you are caught between risk of peripheral infusion on an infrequent basis and the risk of any type of CVAD insertion when it is only needed sporatically. Combine this with the fact that these kidney disease patients have very few peripheral veins usually and now you have a huge dilema The best you might be able to do is to use a 24 g in as large a vein as possible, never stick in area of joint flexion and pay close attention to catheter stabilization. This is what I teach for those few days when you are waiting on culture results to know if the vancomycin is going to be changed or continued for several weeks. Lynn