500 cc of Vanco/Ns over 2 hours via pump via picc line

[lumbarpain, ADN, RN]

Another poor nurse had an 58 year old female..obese, patient tonight, a new admission with a ton of meds..including a PICC line that an order read to give 500 cc Vanco and 0,9 NS through her Picc line in 2 hours......She is diabetic, was positive for MRSA., asthmatic, amongst other things...3 nurses decided that this was too much to give this woman in 2 hoursm ...we all discussed this her hospital record was a mile long.......we don't get many Picc lines or IVS on our floor...but the order read 500 cc over 2 hours....Isnt this too much in a matter of 2 hours thru a PICC?

[ArmaniX, MSN, APRN]

Are you in a hospital? Was it a loading dose? Perhaps per her size it is the necessary dose. I'd have consulted pharmacy prior to administration if I was concerned with the dose.

But with your question you seem more concerned with the actual volume of drug (500mL) versus the dose mg. If the dose was accurate then I see no problem in this woman receiving the antibiotic at 250mL/hr. The fact that it is going through a picc is wonderful as you won't lose your access site or worry about vein integrity.

Maybe I'm missing your concern, if so please explain further?

[flyersfan88]

What was the actual dose? Not the volume of diluting solution. Did anyone reference micromedex/other pharmaceutical reference?

[TheSpectator]

This rate is the standard in our hospital. We would only change it per MD order if the pt has a condition that would benefit from fluid restrictions. Hope this helps :-).

[Coriander, BSN, RN]

This rate is normal for our unit, too. We have a lot of central lines and vanco.

[MunoRN, RN]

That's well within the flow rate capacity of a PICC. A "Power" lumen is rated for 300 cc per minute and even non-power lumens can handle significantly more than 250 cc/hr.

[proud nurse, BSN, RN]

This rate is normal for our unit, too. We have a lot of central lines and vanco.

Same here. Vanco is a commonly administered antibiotic on my unit, and I'm pretty sure I've hung this dose at this rate.

[applewhitern, BSN, RN]

It isn't the amount of the fluid the vanc is mixed in, but rather the actual dosage of vanc that matters. Vancomycin can cause unwanted side effects if administered too fast. 250 cc per hr is fine for a PICC.

[nrsang97, BSN, RN]

Yes this is a normal rate of vanco per peripheral IV or PICC. The dose is probably in that large volume due to the amount and the dose is based on her size.

[mmc51264, BSN, MSN, RN]

Agreed, what is the actual DOSE? We have several doses that are sent in 500mL. the time it is run over depends on amount of actual medication.

[Altra, BSN, RN]

Can you explain if your patient had a fluid restriction, or why you were otherwise concerned about an adult patient receiving 500mL over a 2-hour period?

And what input did the ordering physician have, when the order was questioned?

[blondy2061h, MSN, RN]

No, a PICC can easily handle tgat rate. A peripheral IV can handle that rate. We run fluids at 999 if some is tanking their pressure, and sometimes, if they're realky tanking, we'll run two pumps at 999.

It does sound like if the dose was in 500 ml the pharmacy prepared it for peripheral admin. Our peripheral doses are in 500 ml and our central doses are in 100-200ml.