How long is too long to give "No PIV meds" in a PIV?

[Pat_Pat RN]

So, how long?

For instance, I have a patient that was admitted Friday night, he was ordered Vanco 1gm Q12hrs. He is "probably" going to be D/C'd tomorrow on PO Vanco. INS says not to give Vanco through a PIV. I could not get the doctor to order a PICC; and I don't think that it is really necessary. The fellow has a good 20ga in an AC vein, he hasn't complained of any pain, etc. Everything seems to be going well.

I'm trying to get a PICC team/person/protocol for when we need one set up at our facility. So my question isn't just simple conjecture.

Does INS or AVA give a time limit that "no PIV" meds can be given through a PIV? I think INS says something like, "in emergency" or "until central access can be made" or some such....

What say you?

Thanks

Pat

[hypocaffeinemia, BSN, RN]

From globalrph.com:

ackage Insert Data:

Thrombophlebitis may occur, the frequency and severity of which can be minimized by administering the medicine slowly as a dilute solution (2.5 to 5 mg/ml) and by rotating the sites of infusion.

Infusion-related events are related to both concentration and rate of administration of vancomycin. Concentrations of no more than 5 mg/mL and rates of no more than 10 mg/min are recommended in adults. In selected patients in need of fluid restriction, a concentration up to 10 mg/mL may be used; use of such higher concentrations may increase the risk of infusion-related events. Infusion-related events may occur, however, at any rate or concentration.

Important points:

* Consider a central line for long term therapy.

* A peripheral IV site should be monitored for pain, redness or swelling prior to initiating the infusion and every 30 minutes until the completion of the infusion.

Of consideration:

Vancomycin PO doesn't for anything but gut-related infections (C. diff colitis for instance). No real system absorption that route.

[Kymmi]

Im sorry but I really do not understand the question. I've read it 5 times and I still do not understand what you want to know.

[EarthChild1130]

This doesn't exactly answer your question, but it does give some interesting info on Vanco..

http://www.clinicaliq.com/content/vanco.pdf

My best answer would be to use the policies/procedures for your facility and, if there isn't one, talk to the higher ups about getting one put in place, which, from your post, appears to be happening!

When I did work med/onco, we would run Vanco through a PIV ONLY until we got PICC access (at most one day)

[Pat_Pat RN]

Im sorry but I really do not understand the question. I've read it 5 times and I still do not understand what you want to know.

My quesiton is: Even though giving Vanco through a PIV isn't recommended by INS and AVA, how long can it be given that way.

[Pat_Pat RN]

From globalrph.com:

Of consideration:

Vancomycin PO doesn't for anything but gut-related infections (C. diff colitis for instance). No real system absorption that route.

So if it is MRSA and the 3 days +- of IV didn't get it, then the PO won't do anything. He might change the PO to something else....

Thanks!

Pat

[hypocaffeinemia, BSN, RN]

My quesiton is: Even though giving Vanco through a PIV isn't recommended by INS and AVA, how long can it be given that way.

The answer is "if you're discharging the patient tomorrow and aren't planning on home vanco IV therapy, don't worry about it".

[hypocaffeinemia, BSN, RN]

So if it is MRSA and the 3 days +- of IV didn't get it, then the PO won't do anything. He might change the PO to something else....

Thanks!

Pat

Yeah. And the doctor that wants to prescribe PO vancomycin for a non-enteral staph infection needs a swift kick to the side of the head.

[Pat_Pat RN]

The answer is "if you're discharging the patient tomorrow and aren't planning on home vanco IV therapy, don't worry about it".

I know that THIS time. But the docs here aren't real keen/impressed/founded in facts....?? So how long *can* you keep putting it in a PIV. I'm trying to get a cut-off from someone to tell the docs here, "If you are going to want them to have (Vanco/Zosyn/whatever) for more than "X" days/doses then they need a PICC.

[hypocaffeinemia, BSN, RN]

I know that THIS time. But the docs here aren't real keen/impressed/founded in facts....?? So how long *can* you keep putting it in a PIV. I'm trying to get a cut-off from someone to tell the docs here, "If you are going to want them to have (Vanco/Zosyn/whatever) for more than "X" days/doses then they need a PICC.

There is no magic answer to give you. Depending on where you read, you'll just see a "suggestion" that vanco be given via central line for long term therapy to INS stating that you should always use a central line.

This is something that should likely be decided and put into policy by the P&T committee at your facility.

As for Zosyn, I've not heard of a requirement or suggestion recommending avoiding peripheral IVs.

[perfectbluebuildings, BSN, RN]

Goodness... never heard this. We give vanc all the time via PIVs, for several days at a time. Not really practical to start PICC lines on all patients with an MRSA abscess who will only be there 3 or 4 days usually... You learn something new on this site every day.

[roser13, ASN, RN]

"Vancomycin PO doesn't for anything but gut-related infections (C. diff colitis for instance). No real system absorption that route."

"the doctor that wants to prescribe PO vancomycin for a non-enteral staph infection needs a swift kick to the side of the head."

I've missed something - seriously? PO Vanco is worthless against MRSA unless it's enteral?