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at our hospital i believe the policy is that a cvl must be placed within 12 hours of starting a vasoactive medication (dopa, neo, etc) that way if someone is posibly just needing short term help they won't necessarily be put through having a cvl placed. That being said, usually we push for one to be put in asap. We usually run amio through peripherals without a problem.
Do it frequently. I just had a lady last night on Dopamine with "old lady" veins. She was an ICU hold in the ED. She had a 22G and a 24G. ED doc wouldn't put in a central ("she's not my patient anymore") and the admitting wouldn't come in at 2300 on a Saturday night. So she got Dopamine through a peripheral line---which was CLOSELY monitored. Also she people on pressors with no A-line....gasp:eek: Not perfect, but we do what has to be done.
I don't think we have a specific policy regarding this issue, however if it is approaching the 24 hr mark, we start waving central line kits in front of the docs' faces. I guess if it is an emergency, however, and no central access, then one has to weigh the risks and benefits of "right here, right now, this is what I have to work with."
cvryder
114 Posts
I was always taught that dopamine should only be infused through a central line (CVL, PICC, whatever). In every facility I've worked in previously, you had to have a specific order to give it peripherally. At the hospital where I am currently a traveler on a cardiac floor this is apparently not so. I came in one night to an order to start a dopamine drip on a patient who had *only* a peripheral line. I was very uncomfortable with this and questioned it. I was told (rather disapprovingly) "We do this all the time." Since then I have seen that indeed they do. I am still really uncomfortable with it. Amiodarone is also infused peripherally here.