List of Meds that MUST be given through a central line

DLS_PMHNP, MSN, RN, NP · May 20, 2012

did you google it?

justchill, BSN, RN · May 20, 2012

Yes I did. Mostly just found forums asking about one particular med, procedures on how to give meds through a central lines or things about irritants and vesicants. I'm just basically asking if anyone knows of a nice comprehensive list somewhere is all.

IndyElmer · May 21, 2012

Using google, I found several webpage sources that mentioned that drugs prone to causing phlebitis in peripheral veins should be given via a central line. However, I am not comfortable with any of the sources as "quality" sources.

If you are daring enough to accept that assumption regarding phlebitis, the following article mentions some drugs that are more likely to cause phlebitis (and I think most/all were on the lists about central lines). See the first column on page 3 - http://www.nursingcenter.com/pdf.asp?AID=765665

Also, if you have online access to a drug guide, you may be able to search for key terms like "large vein" or other terms (sorry, I forgot which other ones I used). In the Davis online access, searching "large vein" brings up 18 or so drugs. Most, if not all, were on the previous "general" lists.

Sorry it's not a complete list, but it might be a start.

anonymousstudent · May 21, 2012

I have never encountered a medication that could only be given through a central line, nor been taught about any in pharm. That leads me to believe it's not common, and it's not something I (or you) need to know as nursing students or entry level nurses. Not that it's not OK to wonder, but we sure have a heck of a lot of info to learn without piling more on.

I'm sure they exist. My guess is these are meds you'd only encounter in specialized practice, in a critical care setting, or chemotherapy agents, as an example.

It would be better to use a central line if you had the access for some things though...

Double-Helix, BSN, RN · May 21, 2012

The biggest ones that have to be given through a central line are CONCENTRATED medications. Most particularly, electrolytes. You can dilute almost anything to the point where it can be given through a peripheral line, but if you want to give medications in higher concentrations, you need a central line to avoid damaging the vein.

Examples: Potassium greater than 10 mEq/hr, Dextrose greater than 12.5%

The BEST place to look for this information is the policy and procedure manual at your facility. They should have policies regarding which medications need to be given centrally.

KelRN215, BSN, RN · May 21, 2012

The preferred route for 3% Normal Saline is via a central line but not everyone who needs it has a central line and if a patient needs 3% Normal Saline, it's unlikely that you have the time to wait for central access before you start it. When I worked actue care, my floor was one of the few floors outside of the ICU where we were allowed to give 3% normal saline (neurology, the lowest sodium I ever saw was 117) and sometimes it was necessary to give it peripherally.

TPN is the only other thing I can really think of that requires central access but, again, if necessary you can give PPN (peripheral PN)- the nutritionist and pharmacy just need to know that it is intended to go through a peripheral line so the appropriate adjustments can be made.

classicdame, MSN, EdD · May 21, 2012

Vesicants like: Potassium, calcium, Dextrose 10% or greater, Sod bicarb, radiocontrast, ampicillin, vanc, amphotericin B, Nafcillin, dopamine, dobutermine, epi

I believe the Infusion Nurses Society recommends central lines for any med with a specific pH value, like mentioned above. But I have forgotten the value!!! Try www.ins1.0rg

KelRN215, BSN, RN · May 22, 2012

Vesicants like: Potassium, calcium, Dextrose 10% or greater, Sod bicarb, radiocontrast, ampicillin, vanc, amphotericin B, Nafcillin, dopamine, dobutermine, epi
I believe the Infusion Nurses Society recommends central lines for any med with a specific pH value, like mentioned above. But I have forgotten the value!!! Try www.ins1.0rg

I have given almost all of the above through peripherals before. In my old hospital, almost all radiocontrast injections were done via a peripheral IV even if the patient had a central line. I believe you that the recommended route for these meds is central but I can't think of any meds that absolutely MUST be given centrally.

mama_d, BSN, RN · May 22, 2012

I've also given all of those listed a couple of posts up via a peripheral...I've actually got 3 patients tonite on Vanco with peripheral access.

Although I don't recall giving lipids via a peripheral before, it's the only one off the top of my head.

Even chemo can go through a large peripheral access with good blood return...requires diligent monitoring, though.

We have certain meds we won't give above a apecific rate via peripheral...but I'm willing to bet that these vary from place to place.