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Just curious about what your facilities say about the concentration of Levophed and what type of line you need to run it through. I work two ICU jobs right now - one full time, one PRN, and they both have very different ideas about how Levophed should be run.
My full time job says: You can only put single strength Levophed through a peripheral line, and they would prefer not to run it through a peripheral at all. Quad concentration has to be run through a PICC/central line. Quad strength Levophed is just too high risk to run through a peripheral.
My PRN job says: We always mix our Levophed quad strength and almost always run it through peripherals because almost none of our patients get PICC/central lines. Maybe Levophed is dangerous if it infiltrates, but patients needing Levophed are more likely to have some heart failure, and single strength Levophed is going to give them way too much fluid. Which do you prefer - the risk of a little bit of infiltration and damage, which should be low because you're going to be using a large vein for your Levophed anyway, or putting your patient on a vent because you overloaded them?
I am still firmly standing by my full time job's policy in that running quad strength Levophed through a peripheral scares the bejeezus out of me, but I can see my PRN job's point on the fluid overload standpoint. When you're running single strength Levophed at 30, and you're going through a 250ml bag in a couple of hours and some change, that's a lot of fluid if your patient is ARF or HF. Should we continue to run it single strength just because the patient only has a peripheral and there is no one available to drop a central line in that case?
What are your thoughts?
By the way, neither of my facilities typically place art lines when we have patients on pressors... but that is its own beast.