Levophed vs. Neo - page 3

Hey all - wondering about how many of your facilities use levophed as 1st line defense for hypotension versus neosynephrine. I'm actually wondering why my MICU docs don't use neo more. I know that in... Read More

  1. by   NtannRN
    Never Levo Peripherally - ever. where I am but we DO use Neosynepherine peripherally. The low dose and usually for a very short amount of time. Usually our surgical patients get a "spash" for a little while. Or while we wait for out lovely residents to put in a central line.
  2. by   detroitdano
    If your patient is about to croak you can run Levo peripherally. It's better than the alternative if you don't have a central line.
  3. by   yliurn
    Neo would make the heart rate slow and stronger besides increase of bp. But the side effect includes peripheral vascular constriction. I think it's our first line drip for bp problem. Levo would increase the heart rate and cause more o2 consumption at heart.
  4. by   damanRN
    Quote from detroitdano
    If your patient is about to croak you can run Levo peripherally. It's better than the alternative if you don't have a central line.
    Quote from lakemurray
    If you go to Merck's drug site it will say that levo should be given through a large vein and must be given through a central line. http://www.merck.com/mmpe/print/lexi...inephrine.html look for I.V. administration. Your hospital should have a policy about drug administration. Every hospital I have been to has had a policy about administering vasoconstrictive drugs through a central line. Extravasation will cause necrosis. That being said it looks like you are a new nurse and you probably do not want to make too many waves.
    Quote from NtannRN
    Never Levo Peripherally - ever. where I am but we DO use Neosynepherine peripherally. The low dose and usually for a very short amount of time. Usually our surgical patients get a "spash" for a little while. Or while we wait for out lovely residents to put in a central line.

    I think you need to go back and reed the Merk manual again. It says levo only through large vein, the must be given through a central line is when given with bicarb. All of this talk (by multiple individuals) about "never through a peripheral" is ungrounded. "Sorry sir, I have this medication that could restore perfusion to your wife's organs and possibly save her life but I won't give it because she only has a peripheral I.V." Not all patients have a central line and not all hospitals have a doc (willing) to put one in on a stat basis. Assess the site frequently and have regitine on standby if need be until they have a central in place.
  5. by   detroitdano
    Why was I quoted in that mess? I agree that Levo can be given peripherally. It's been known for decades that if it infiltrates it can become a giant mess, but as I said, if you have to pick between a dead patient or a necrotic arm, you obviously don't have much of a choice and it's worth the risk.
  6. by   damanRN
    quoted to second your post
  7. by   NtannRN
    I stand corrected. I went back to work and asked my senior nurses. Yes we do give it peripherally but we try to never do that. We also try to give bicarb alone without anything running with it. I don't know why the Gerhart iv book we use has compatibilities. No one at work is able to tell me why we give it alone either.
  8. by   lakemurray
    Apparently you cannot read. I even posted the web link. Levo requires a central line. Also where do you people work at that you give vasoconstictors without central lines? In the er while waiting for a line maybe, but not on a unit. I have not worked in a unit where we put any vasoconstricter without a central line for at least five years. Think about it. If its not going in (extravasating) whats it doing for you patients blood pressure. That sad nonsense about your wife going to die but we can't use a vasoconstrictor peripherally is nonsense. The first thing your going to do is a fluid challenge and while that is going on you get a central line placed.
  9. by   registeredin06
    to lakemurray....you've got to realize that not all hospitals are fortunate enough to have a 24 hr intensivist. Think of the hundreds of small town community hospitals where a doctor cannot/will not make it in at 0200 within an hour. Fluid challenge??? really?? how long can that hold you over in the eyes of vasodilatory shock?? I'm sure all critical care nurses with experience would agree, peripheral infusion of norepi is not the preferred route, and is only used in extreme cases when a central line is not possible.

    I think you owe some of these posters an apology for attempting to make them feel like incompetent nurses. The point was, and still is, sometimes you have to do your best with what you've got, in the best interest of the patient.
  10. by   RNforLongTime
    I work in a small community hospital ICU. We run pressors peripherally ALL the time. We try to push for a central line but this is a VERY Doctor oriented hospital and are often ignored. LIke the PP said, you do with what you have in the best interest of the patient.
  11. by   damanRN
    Quote from lakemurray
    Apparently you cannot read. I even posted the web link. Levo requires a central line. Also where do you people work at that you give vasoconstictors without central lines? In the er while waiting for a line maybe, but not on a unit. I have not worked in a unit where we put any vasoconstricter without a central line for at least five years. Think about it. If its not going in (extravasating) whats it doing for you patients blood pressure. That sad nonsense about your wife going to die but we can't use a vasoconstrictor peripherally is nonsense. The first thing your going to do is a fluid challenge and while that is going on you get a central line placed.

    why would it say infuse into large vein if it can only be given in central line? are people putting central lines into small veins? The websit YOU sited states
    "Administration: I.V.
    Administer into large vein to avoid the potential for extravasation; potent drug, must be diluted prior to use; do not administer NaHCO3 through an I.V. line containing norepinephrine. Central line administration is required. " The central line is required statement is r/t the NaHCO3 and levophed combo. it goes on to say
    "Administration: I.V. Detail
    Administer into large vein to avoid the potential for extravasation." The ac is a large vein.

    Up to date removes the ambiguity of the merk info. look up levophed on up to date you'll find this:
    "Administration
    Administer into large vein to avoid the potential for extravasation; potent drug, must be diluted prior to use; do not administer NaHCO3 through an I.V. line containing norepinephrine." same exact thing without the central line confusion.
  12. by   Lucyinthesky
    Quote from lakemurray
    Apparently you cannot read. I even posted the web link. Levo requires a central line. Also where do you people work at that you give vasoconstictors without central lines? In the er while waiting for a line maybe, but not on a unit. I have not worked in a unit where we put any vasoconstricter without a central line for at least five years. Think about it. If its not going in (extravasating) whats it doing for you patients blood pressure. That sad nonsense about your wife going to die but we can't use a vasoconstrictor peripherally is nonsense. The first thing your going to do is a fluid challenge and while that is going on you get a central line placed.
    I think it is agreed by all that the BEST route is via a central line but this is not immediately possible in all hospitals. While you are awaiting your central line Levophed may be necessary in a WORKING peripheral vein. If it was extravasating as stated above you wouldn't be giving ANYTHING through that vein let alone levophed. If it is a critical situation you don't have time to wait for a central line to be put in and need to work with what you have on hand to stabilize the patient.
  13. by   meandragonbrett
    Quote from lakemurray
    Also where do you people work at that you give vasoconstictors without central lines? In the er while waiting for a line maybe, but not on a unit. I have not worked in a unit where we put any vasoconstricter without a central line for at least five years.
    Not everybody works in the type of facility where you work. Some of us work in non-teaching private hospitals where there is nobody in house at night and you're told to deal with what you have. In a perfect world, a CVL would be admission criteria for the unit.

    Lots of facilities run pressors in a PIV on a routine basis...especially in the middle of the night. Kinda hard to place a CVL when you have a pressure in the 40' and 50's anyways.

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