New infusion center...new protocols

  1. Hi All,

    So I recently started at another infusion center and have found their practices much different from my last facility. Does anyone treat iron products like feraheme as a vesicant? I placed an IV in a woman in her AC in 1 stick d/t lack of other options (we stuck her 9 times the week before) but my manager told me that it is unsafe in her AC d/t vesicant like properties of the drug. So I reviewed the medication (and other iron products) on uptodate and lexicomp and did not find anything....and neither did she. Regardless, I still had to stick the patient a few more times to get another location. Does anyone else do this with iron products?

    Furthermore, my facility is very strict about not using the AC and actually prefers nurses to use hands for all chemotherapy. Which I get the idea of working your way up in case it infiltrates, but still I am used to looking for the best vein to handle chemotherapy. I do try to avoid AC if possible anyways and typically go for the forearm. And it even says in the extravasation policy to avoid hands but my manager comes around and tells me I have to start there. I have no problem if the patient has decent veins but many patients have poor access. Anyone do the same?
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  2. 1 Comments

  3. by   IVRUS
    Quote from MCU1187
    Hi All,

    So I recently started at another infusion center and have found their practices much different from my last facility. Does anyone treat iron products like feraheme as a vesicant? I placed an IV in a woman in her AC in 1 stick d/t lack of other options (we stuck her 9 times the week before) but my manager told me that it is unsafe in her AC d/t vesicant like properties of the drug. So I reviewed the medication (and other iron products) on uptodate and lexicomp and did not find anything....and neither did she. Regardless, I still had to stick the patient a few more times to get another location. Does anyone else do this with iron products?

    Furthermore, my facility is very strict about not using the AC and actually prefers nurses to use hands for all chemotherapy. Which I get the idea of working your way up in case it infiltrates, but still I am used to looking for the best vein to handle chemotherapy. I do try to avoid AC if possible anyways and typically go for the forearm. And it even says in the extravasation policy to avoid hands but my manager comes around and tells me I have to start there. I have no problem if the patient has decent veins but many patients have poor access. Anyone do the same?
    Feraheme has an Okay pH and Okay Osmolarity as far as that goes... But the pH or Osmolarity of a drug cannot be the only thing one looks at. Take Naficillin, for example, it too has an Okay pH and Osmo, but is considered a Vesicant secondary to its excipients. Whether those additives are Alcohol or Buffering agents, sometimes these excipients, or what goes into getting that drug into the IV form, is what causes it to be really harsh on the veins. The ACF is really never a good place to cannulate secondary to the intense damage to the Tunica Intima. Personally I would advocate for this patient to receive a PICC or Port, if this individual has many Infusions in the near future. Sticking someone 9 times, is crazy.

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