Levophed concentration and hospital policy.

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  1. Levophed and PIVs?

    • 6
      We always run quad strength Levophed through peripherals.
    • 58
      Levophed through a peripheral?! Horrifying!!!
    • 30
      We run Levophed through peripherals, but only single concentration.
    • 4
      We almost never put art lines in patients on Levophed
    • 38
      We use art lines for our patients on pressors.

18 members have participated

Just curious about what your facilities say about the concentration of Levophed and what type of line you need to run it through. I work two ICU jobs right now - one full time, one PRN, and they both have very different ideas about how Levophed should be run.

My full time job says: You can only put single strength Levophed through a peripheral line, and they would prefer not to run it through a peripheral at all. Quad concentration has to be run through a PICC/central line. Quad strength Levophed is just too high risk to run through a peripheral.

My PRN job says: We always mix our Levophed quad strength and almost always run it through peripherals because almost none of our patients get PICC/central lines. Maybe Levophed is dangerous if it infiltrates, but patients needing Levophed are more likely to have some heart failure, and single strength Levophed is going to give them way too much fluid. Which do you prefer - the risk of a little bit of infiltration and damage, which should be low because you're going to be using a large vein for your Levophed anyway, or putting your patient on a vent because you overloaded them?

I am still firmly standing by my full time job's policy in that running quad strength Levophed through a peripheral scares the bejeezus out of me, but I can see my PRN job's point on the fluid overload standpoint. When you're running single strength Levophed at 30, and you're going through a 250ml bag in a couple of hours and some change, that's a lot of fluid if your patient is ARF or HF. Should we continue to run it single strength just because the patient only has a peripheral and there is no one available to drop a central line in that case?

What are your thoughts?

By the way, neither of my facilities typically place art lines when we have patients on pressors... but that is its own beast.

Specializes in MICU.

At my facility I have only seen Levo as 8mg/250ml. I assume that's that you mean by single strength. I think we can have pharmacy double concentrate it but we usually don't. Our docs are getting better about placing central lines or ordering a picc but we occasionally run it via peripheral. Usually it is only through a peripheral if it's a few mcg or less. Our range is 5-30 mcg/min but in dire situations I've had it as high as 50, as long as the doc is aware. Usually we go >30mcg/min another gtt is on the way.

Specializes in MedSurg, ICU.

We do Levophed through peripherals if we have nothing else. Usually they have a PICC/ CL if they're sick enough to require Levo. However, working nights, most of the times when our patients crash, we don't have the luxury that days does to get one. We're extremely careful when we have to though. I think if they're sick enough to require Levophed, they're sick enough to buy themselves a central line.

Specializes in Current: ER Past: Cardiac Tele.

I work in the ED and we will run the 4mg/250ml for peripherals and 16mg/250 for PICC/CL.

Sometimes the MD isn't willing to place an central line before sending the patient up to ICU.

Specializes in NICU.

We can run levophed 4/250 through a PIV and 16/250 and 32/250 through central lines only. We don't have anyone to put in CVCs at night, though, so we're often without any options. I ran levophed through a #22 in a patient's thumb a while back because we had no other access. Sometimes it's a fight to get a central line even on day shift. I had a little lady with ischemic limb from a pressor running through a PIV in her forearm for 48 hours because no one would drop a central line.

Arterial lines are only ordered once a second pressor is started, and sometimes not even then.

At my hospital - Levophed can be run at a 4/250 concentration through a peripheral - but this is temporary until a central line can be placed. The central concentration is 8/250 or 16/250, with 8/250 being much more common. Patients in the ICU where I work do not typically get an arterial line unless the cuff pressures for whatever reason appear to be unreliable OR the patient looks like they are headed for more than one pressor.

We do Levophed through peripherals if we have nothing else. Usually they have a PICC/ CL if they're sick enough to require Levo. However, working nights, most of the times when our patients crash, we don't have the luxury that days does to get one. We're extremely careful when we have to though. I think if they're sick enough to require Levophed, they're sick enough to buy themselves a central line.

Agreed, running Levo through a peripheral as anything other than temporary measure while a central line is being dropped is medical malpractice, in my opinion.

Specializes in SICU.

Maybe we are just lucky but our fellows are remarkably fast about lining patients (central/art) so we don't usually run into the peripheral issue, also being such a high acuity hospital, patients who come to us usually have some sort of central access anyway..

Specializes in Quality, Cardiac Stepdown, MICU.
You have only 1 Physician on for a 400 bed hospital with 48 ICU beds? Even if this is (hopefully) only at night that doesn't sound like a hospital that should be taking patients.

Similar numbers in my hospital. At night, the ER doc, and the night hospitalist, who covers the whole house EXCEPT the ICUs. We have EICU for that. (And they cover not only the 3 ICUs in our building, but those at 3 other hospitals.)

Though I have seen an intensivist called in by the EICU come in at 3 am to start a line on a pt that needed it. During the day the intensivist's ARNP usually drops the lines. Our IV therapy nurses usually stay until 2100.

Generally agree with the "if they're sick enough for pressors, they're sick enough for a line" statement.

We don't rush to throw in an A-line unless they're getting frequent vent changes, for ease of doing gases. In fact, I rarely see one put in just for BP monitoring; cuff pressure is usually considered adequate.

at my facility the policy is to run any strength levophed gtt in a picc or central line. may start levophed gtt if pt only has a piv site but will need a picc line as soon as possible. pharmacy frowns on quad strength in piv, only in renal and chf pts will pharmacy make acception.

With a pt who is septic, fluid is needed in the body and single strength is ok as far as volume goes. The more concentrated a medication is, the more irritating it is the the vein. Thus making it more dangerous for infiltration of medication into tissue.

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