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?

[blackvans1234]

We usually have 125ml/hr for a total of 250. Honestly I cannot tell you how many mg of vanco it is.

[Altra, BSN, RN]

I think we could debate all day what typical doses of Vanco we all see typically in our various care settings, but the confusion centers on the OP's concern over 500cc - it is repeated more than once in the post - and its delivery via a PICC, without explanation regarding a fluid restriction or other contraindication.

[RunninOnCoffee]

Our facility puts vanco in 250 ml bags. Most I run is 94ml/hr due to the concentration. Vanco can be ototoxic so it's more so the mg/he to be concerned of like other posters have already mentioned.

[Karou]

Like other posters, my biggest question is what is the dose of the vancomycin?

What about the idea of 500cc over two hours via a PICC line concerns you? Is it the rate? The rate is 250cc an hour. That's no problem with a PICC. Is it the PICC itself? The PICC is better than a peripheral IV for vanc because it will hold up to vesicants drugs. Does the patient have CHF? Are you concerned about fluid overload? If so, then you need to discuss that with the prescribing physician or pharmacist.

We want to hear back from you, OP!

[sugarwahine10]

We give vanco a lot on our floor and I've given 1500 mg in 275ml bag in a peripheral iv over approximately 2 1/2 hours quite often and with no issues.

[blondy2061h, MSN, RN]

Our facility puts vanco in 250 ml bags. Most I run is 94ml/hr due to the concentration. Vanco can be ototoxic so it's more so the mg/he to be concerned of like other posters have already mentioned.

UpToDate recommends 30 minutes per 500mg, slower if redman's syndrome.

[lumbarpain, ADN, RN]

THank you everyone.....being I haven't done PICC lines or IVS for some time...and the other nurses seemed to question this also because their experience is slim also...I appreciate it.....our management just throws things at us when we need inservices on important things like IVs and PICc LINEs and I MEAN hands on stuff...NOt just talking about it....thanks

[psu_213, BSN, RN]

THank you everyone.....being I haven't done PICC lines or IVS for some time...and the other nurses seemed to question this also because their experience is slim also...I appreciate it.....our management just throws things at us when we need inservices on important things like IVs and PICc LINEs and I MEAN hands on stuff...NOt just talking about it....thanks

Does your unit do any education about IV therapy and PICCs? Part of the reason I ask--there was a long thread on here recently that focused on a nurse being disciplined for not doing PICC dressings. Who does the dressing changes on your unit?

This is not meant as a criticism of the OP, but it just doesn't seem like a wise idea for nurses to infuse meds via PICC when there seems to be a knowledge deficit amongst the nurses on the unit regarding PICCs. Are they used for blood draws also?

[SierraBravo]

OK, from a pharmacological perspective... Vancomycin being infused into a peripheral vein SHOULD NOT exceed 5mg/mL with respect to the prepared concentration. That is why you see the commercial bags of 1g Vancomycin in 200mL (1000mg/200mL=5mg/mL). The biggest dose you should see in a 250mL or 275mL bag is 1.5g. Once you get above 1.5g you need to move to a 500mL bag in order to not exceed a 5mg/mL prepared concentration. If you are giving the drug centrally you can technically give a more concentrated variant of the drug (i.e. less volume). However, commercial manufacturers are not going to make a peripheral and a central version of the same drug, that would be a med error waiting to happen. Plus, not everyone has central lines, so by default you basically always get the peripheral concentration of the med.

Now, infusion rates should typically be a little bit longer for the larger doses. We run 1g over 1.5 hour, 1.25g & 1.5g over 2 hours, 2g & 3g over 3 hours.

Vancomycin is not only potentially ototoxic, but also nephrotoxic. Obviously the problem is two-fold in terms of infusing it too fast, not only could the patient not tolerate that rate of infusion volume wise, but they could also develop red mans syndrome or oto and/or nephrotoxicity.

It also worries me that the OP infused something into a central line which they weren't completely familiar with.

[tyvin, BSN, RN]

The reason Vanco is given at what might be considered a slow rate is that there can be numerous side effects when given too fast.

https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=4&cad=rja&uact=8&ved=0CC0QFjAD&url=http%3A%2F%2Fwww.globalrph.com%2Fvancomycin_dilution.htm&ei=FQxDVay7Fou1oQTC0YGQDA&usg=AFQjCNG4y2YCkKgwEMqhgAX96ZhZG79xpA&sig2=cZMyM4a438nJVPla_dYsmA

[Here.I.Stand, BSN, RN]

That's a standard volume for Vanco to come in. I'm not sure what dose it was--I don't think I've ever given Vanco over longer than two hours, though.