Today, I had a patient admitted with elevated LFT's, fever, and suspected gangrenous cholecystitis. She was ordered a STAT CT scan of the abd/pelvis and started on meropenem and vancomycin. Also, she needed transfused with 2 units of PRBC's for a hemoglobin of 5.9. Her venous access was TERRIBLE! She had one peripheral IV (20g in the right FA), and I managed to start another peripheral IV (24g in the left hand). Needless to say, the docs wanted her to have a PICC line placed. Her antibiotics were schedule for 1pm, so I called radiology to find out when they could take her and was told it would be before 3pm. The PRBC's were transfusing throughout the day, so that occupied one line. Around 1pm, she wanted something for pain, so I went to give her something and she complained that her other IV was painful when I flushed. I removed the IV and then re-scheduled the antibiotics for 7a-3p-11p (was originally 5a-1p-9p). I did this so that her IV antibiotics would not be late and would not be administered too close together. She went down for her PICC line around 2:30pm and was still in radiology when I gave report to the next shift. The RN and her orientee both gave me a strange look when I told them about this scenario. I was asked why I didn't give the antibiotics through the other IV and explained that I did not feel comfortable giving vancomycin through a painful 24g IV in the hand. I also reinforced that she still had PRBC's infusing. I still don't think my rationale was understood.
My question is... does it seem like I did the right thing? I know antibiotics are extremely important, but I did not want to create any other problems - like a vancomycin extravasation! Any thoughts on my actions? What would you have done?
