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

[lumbarpain]

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?

[MXRobRN]

Assuming it's dose adjusted based on the the patients BMI (per pharmacy), there is nothing wrong running that rate of fluid through a PICC, as others have said.

Oftentimes I see those 500cc Vanco bags ordered to run in over 1.5 hours, which is an order I prefer not to see on pt's that only have peripheral access. Pharmacy times it that way for a reason, though.

[Libby1987]

We do it at home.

[ArmaniX, MSN, APRN]

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.

Why are you running it via an IV pump versus pressure bag if their blood pressure is tanking?

[Coriander, BSN, RN]

Why are you running it via an IV pump versus pressure bag if their blood pressure is tanking?

We must use the pumps for safety reasons on the floors at my hospital, even for normal saline. The ER is the only dept that doesn't use them for boluses.

[VANurse2010]

Why are you running it via an IV pump versus pressure bag if their blood pressure is tanking?

People's definitions of "tanking" vary. A truly tanking patient needs a pressure bag or a rapid infuser.

[blondy2061h, MSN, RN]

Why are you running it via an IV pump versus pressure bag if their blood pressure is tanking?

We don't have pressure bags readily available, always. We have like two for the unit. All of my patients have central access, so this is usually just until whatever pressor we're starting or adding is ready to go.

[blondy2061h, MSN, RN]

People's definitions of "tanking" vary. A truly tanking patient needs a pressure bag or a rapid infuser.

No, I'm talking 60/20 or no audible BP at all. Truly tanking. That was the last patient I did two lines at 999 on. He was transferred to us like that and one of our rare patients without central access. We did that while a CVL was being placed for dopamine and levophed.

[ArmaniX, MSN, APRN]

Blondy2061h that seems so abnormal to me. I guess different practices in different hospitals. If I had a patient tanking at 60/20 and began to put it on a pump I would never here the end of it. That is not a viable bolus by giving the liter over an hour.

My icu (and even our SDU) keep pressure bags on all code carts and even fully stocked in our supply room. That is the expectation within my hospital system however.

And I don't understand, from another commenter, how running a bolus via pressure bag is seen as a safety issue. When a patients pressure is dropping and there is an order for bolus.. you bolus.

Not demeaning anyone. I just find the practice variation strange.

[blondy2061h, MSN, RN]

I agree it's strange. It really isn't done as a full corrective measure, just a hold over until the pressor started. The fluid bag and tubing and pump were all already there, so it wasn't like I was there priming tubing and plugging in s pump.

[CT Pixie, BSN, RN]

I run Vanco routinely and daily on a lot of my patient. 2 hrs is about right.

I'm not understanding the concern that you and the 3 other nurses had. Is it the amount running, that its going through a PICC, was it the dose (which wasn't stated in your orig post)?

[RNJill]

The other conditions/issues listed seem irrelevant to the vanc dose issue...obesity, multiple comorbidities, tons of meds, etc. They definitely seem like things that shouldn't affect the rate of vanc too considerably for the patient. Vanc is typically one of "those" meds/antibiotics for the chronically ill/multiple comorbidities/MRSA + patients only, so seeing it along with a laundry list of meds shouldn't be surprising. A large dose (still would kind of like to know the mg amount) on a newly admitted patient would not be surprising esp in the case of a new or worsening infection.

IDK if you have a pharmacist available or even micromedex/Epocrates, but your workplace should have at least one of those resources available to you be it online or in person. That way you can objectively verify doses and interactions with other meds. I would be concerned about deciding to hold IV meds, esp abx, or change dosing rates dramatically based on the opinions of others/yourself...it seems like a good way to be questioned in the future about why an unwise decision was made (NOT an attack, just thinking back to my RN days and giving zillions of meds).

[dianah, ASN]

Just curious, was the order for Vanco 500mg (not ml) in 250ml NS to run over 2 hr??

Our pts usually receive 1gm Vanco in 200ml over 90-120 min, pre-procedure.