antibiotic administration

I always choose a central line over peripheral any day. You can run fluids faster and don't have to worry about vesicants. It also gets distributed into circulation faster as the tip of the catheter is in or near the right atrium. So for things like pressors and colloids for unstable patients, of course it has clinical benefits. For antibiotics, I'm not sure seconds matter. Vanc isn't going to save someone's life if it's circulated 1 minute faster.

Vanco is so hard on veins, I would have used the port.

Vancomycin can be very irritating to peripheral veins and if it infiltrates, there can be damage to the surrounding tissues. If you have a central line, there's no reason no to utilize it for antibiotics. Even if you had an antibiotic running and you needed the central line in an emergency, you can easily stop the Vanco infusion and give your emergency meds.

Provided the PIV is working correctly, the effects of administration will be the same either centrally or peripherally. But the risk of infiltration is higher and the PIV is more likely to develop complications. There also can be some benefit to the port/central line- when you infuse antibiotics through the line it can help reduce the chance for infection in the line.

Was this an inpatient situation with the port already accessed? If the port was not accessed and the patient had a PIV (maybe in an outpatient clinic) I probably wouldn't access the port just to give one dose of Vanco, because the discomfort and the infection risk during accessing is greater with the port than a PIV. But if the port was already accessed or the patient was inpatient and would be receiving frequent infusions, I would definitely use the port.

This may be a totally off-the-wall question, but ... any chance that no one knew about the port on admission (like it was missed)?? On several occasions, I have been the one to notice a port several days after an admission

Could be the reason why they were doing ABT peripherally. Wouldnt be the first time a port was missed. (Usually this occurs when the pt questions why we're doing traditional venipuncture for labs and not accessing the port.)

This may be a totally off-the-wall question, but ... any chance that no one knew about the port on admission (like it was missed)?? On several occasions, I have been the one to notice a port several days after an admission

Could be the reason why they were doing ABT peripherally. Wouldnt be the first time a port was missed. (Usually this occurs when the pt questions why we're doing traditional venipuncture for labs and not accessing the port.)

This happens a lot. Or, if the port had been used originally for chemo, we wait on the oncologist's okay to access it.

Also, a patient with a port probably doesn't have great veins as it is.

Here is the current recommendation or best practice. Anything with a ph of less than 5 or greater than 9 is best administered through a central line so Vancomycin with a ph of about 2.2-2.4 is best administered through a central line if you have one. This is not to say you cannot give it peripherally it is optimal to use the central line if you have one. Also give any vesicants or irritants and TPN through the central. The nurse in this case is looking at the big picture and preserving the patient's peripheral veins and essentially is preventing peripherally related IV complications. You would also want to check for a blood return on that port and review the tip location and do an assessment on it to rule out any complications. I do agree and often see that a port is missed for use in the ED and other units. I see this mostly because the nurse does not know how to access it or is reticent to do so. The patient will often tell me "I told them but no one listened to me". I am OK with it because I would rather they leave it be if they are uncomfortable with it.

Antibiotics are VERY harsh on the blood vessels and so, in this case, a port/central line would be advantageous. I did an assignment on this in nursing school and found many studies showing it was better.

This is the same reason why with older patients, or with patients who keep tissuing their cannula's, its best to dilute the abx as much as possible and if pushing it, to go slower.

There are many IV medications that are inherently irritating and no matter how much you dilate them will not make them less so. The use of the ph of the antibiotic, or any medication for that matter is is a great quide in determining just how irritating a medication can be.

I also have questions about IV antibiotic infusions. I have 19+ years hospital experience, and I now work as an infusion nurse in an ID office where we infuse antibiotics daily for our patients. My concern is with nurses who have less work experience in general, and only on the job certification for IV therapy. When I have a day off and come back the next day, my patients ask me "why was my infusion so quick yesterday?" I always infuse according to the manufacturer recommendations. The covering nurses will often run the medications much quicker to "get them in & out". I have been unsuccessful at trying to find some information online that explains the importance of following recommended infusion times and the possible consequences of not following the recommendations. I have only been able to find drug specific information. I am looking for something that in general explains the importance of infusing at the correct rate for all medications. Our appointments are spaced & booked to allow for the specific medications and the recommended infusion times, so it is not an issue of not enough time. I know that this issue needs to be addressed but I would like something in print and factual to bring to my supervisor when I take my concerns to her. Can anyone send me a link or give me direction for this?

If I was in your place I would make a list of all the commonly prescribed antibiotics that you are seeing in your practice and then I would look each one up in Betty Gaharts IV medications book and make guide to share with the staff. There are too many drug companies that make antibitics so it will be difficult to find one blanket statement about antibiotic administration. I now we have a chart like this at the hospital where I work. I can tell you this..most adult dosages can be safely administered over 30 min. There are some that need to be given over at least 1 hour such as Vancomycin and then there are the antifungals and antivirals that often require longer infusion times to manage the infusion related reactions and side effects. I guess I am struggling with why a nurse would rush an IV infusion especially on outpatients. often these patients are driving themselves home and should they have a reaction after leaving the center it could be bad ,plus they are no longer being monitored by a nurse. I just would never do that to get my patient out faster and now you know this happening you have an ethical duty to STOP this practice. Please let me know if I can help you with any other resources. In the meantime ,I will check my resources and see if I have anything else that may help you. Keep up the good work. :yelclap:

This happens a lot. Or, if the port had been used originally for chemo, we wait on the oncologist's okay to access it.

Also, a patient with a port probably doesn't have great veins as it is.

That is usually the reason why we don't use a port right away.

Ports do get missed. Usually the patient mentions they have a port, though. Sometimes ports do not work which is also why we don't use them...but for meds like Vanc, always try to administer them through a central line if at all possible.