IV's,a thorn in my flesh.

[ohbet]

When giving 1200mg of vancomycin thru a PICC line why must a filter be used? and can any filter be used? I was told I must use a filter but the one that was previously on the line was no longer available so the head nurse said use the in line filter thats available.

Also the unit has no 250cc NS bags into which the Vanco should be given in so they are withdrawing 250cc out of a 500cc NS bag to make 250cc to give th vanco in,which takes extra time. Why cant we just give the whole 500cc with the Vanco in it?

Also I hate IV therapy cause it takes so much time to prepare the meds,find the equipment ,figure out how much to use and how much to dilute,etc. and etc.

[AmAnRN]

someone at my hospital said the particles in protonix could make you go blind if its not filtered. i am not sure what other side effects.

[SharonH, RN]

This is very interesting. At my facility, we still filter everything except lipids but that's because we don't carry the larger filters. The rationale is to filter out air. Are there studies that say this is no longer necessary?

Also I'm a little surprised about the pharmacy not pre-mixing anything? Why not? This seems like quite a bit of extra work for the nursing staff.

[KaroSnowQueen, RN]

We filter blood, protonix and tpn. never heard of using filters with ABTs, etc.

And your pharmacy doesn't premix anything???? Not even ivf with added K+ in it???? I am amazed at that.

[cindyln]

Does JACHO know that you have to mix IV meds? That was a big problem at my hospital when they came through last,no after hours pharmacist.

[MPHkatie]

there are numerous drugs that need to be filtered, and the rationales are all different, Mannitol for instance needs a filter, because it can crystallize and no one wants crystals in the blood...Others for other reasons, the rationales can be found in a good IV drug manual. (about 30 bucks at barnes and noble) In addition, you can find dilution information as well. Techincally you can give the vanc in 500 cc of fluid, but be sure your patient can tolerate the whole 500 cc's...but your pharmacist should be aware of these sort of unusual practices going on on your unit... (not that I haven't done similar bizarre things- gave 1/2 of a 400 mg premixed bag the other night because thats all we had...

[nurs4kids]

We filter anything that is administered centrally(except lipids), so we'd filter the vanc if it was via PICC, not filter it if it was through a PIV. The reason for not diluting it in the entire 500cc bag is because then you'd have to increase the rate to administer it in a reasonable time. Also, with vanc, if you increase the rate, you increase the likelyhood of having a "redman's reaction". As for mixing meds...???we have always mixed abx and dilute our own..we use burrettes, not piggybacks. what's the deal with JCAHO and mixing abx???

[OzNurse69]

Can anyone tell me the rationale for filtering everything you administer (if that's what you do)? Just curious as to why....

[RNforLongTime]

At my facility, we filter dilantin, mannitol, protonix and anything going through a central line. Never heard of having to filter Vanco. Don't have to mix up piggybacks either, the pharmacy does this.