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Vesicants: Antibiotics versus Chemotherapy

Our institution is going through an entire culture change in relation to early vascualr planning.  I am meeting resistance with staff that patients on Vancomycin should recieve a PICC sooner than later and have stated that patients should recieve no more than 1-2 doses PIV (this covers the surgical prophylaxis patients).  For vesicant administration IVP (chemotherapy) it is our policy to not use a PIV that is more than 24 hours old, we also require that chemo infusions greater than 60 mins require a central line.  I have two questions.

1. Is the term vesicant for chemotherapy based on pH just like antibiotics and gtts?

2. If a patient is recieving a vesicant medication (ex. Vancomycin) through a PIV would it be prudent to change the PIV daily to reduce the risk of extravasation? 

The term "vesicant" means

The term "vesicant" means that it will cause tissue destruction by multiple means. This is not limited to pH for any medication.  For vasopressors, tissue damage comes from vasoconstriction. For some chemo drugs it comes from DNA damage. For other durgs it comes from the other components of the medications.

I think the age of any catheter must be considered for infusion of any vesicant med including vancomycin. However I have never seen a policy calling for routine replacement every 24 hours. I don't think you will have a catheter last much longer than 24 hours for vancomycin infusion though. I would stick to your plans for vanco patients to get a PICC ASAP when the plan of care is known.  


Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

mary ann ferrannini
 We do not give vesicant
 We do not give vesicant chemotherapy through a peripheral anymore. We place PICCs in these patients even if they will eventually get a port. We also place PICCs for Vancomycin administration but do not withhold dosing b/c they do not have a PICC. We do withhold the vesicant chemo we have to prioritize our placements accordingly.
Kathy Kokotis Bard Access

Kathy Kokotis

Bard Access Systems

Sound like you need some articles on vascular access planning

Barton and Danek is a great one, Cost containment by Kokotis myself is good, Hadaway referenced here wrote a good one on giving Vancomycin safely I think in the JIN, I also did an article on chemical plebitis Nursing 98 under kokotis that had why drugs are tough.

I can send you a reference list [email protected]

Kathy Kokotis 


Kathy Kokotis

Bard Access Systems

Kathy, I would love your


I would love your reference list.  I seemed to be going 2 steps forward and 1 step back with the VAP but I am a patient woman!


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