I'm an RN orienting on a medical/telemetry floor. Yesterday, I helped care for a patient w/ESRD (dialysis 2-3x per week). He was admitted to the hospital for cellulitis in the arm with a new A/V fistula (not healed enough to use).
This patient has no IV access-even if a peripheral line is inserted (very hard), it blows with the first dose of IV Dilaudid. He's had too many PICCs in the past and IV therapy refused to even try to start a line on him. He had a permacath placed about 3 days ago and it looks like an abscess has developed.
The docs keep ordering IV medication-specifically Vanc and Gent. My preceptor and I spent nearly all day trying to straighten out this IV access issue (on top of dealing w/a chest pain patient, a GI bleed patient, the list goes on).
Basically, a doc ordered another PICC and the folks in special procedures said one cannot be inserted. IV therapy again refused to try to get another line into him. The doctors told us to run the antibiotics through the permacath as it is his only access and we need to keep that access (hence abx for the abscess).
My preceptor refused to run the abx. I believe that this refusal iwas based on our understanding that it shouldn't be done. The permacath should only be used for dialysis. The docs kept insisting to run the abx in through the permacath.
We ended up calling a dialysis nurse that ran the abx.
Can anyone tell me if this was the right/wrong thing to do or what else could have been done to get the abx into this patient?