Peripheral Line Not for ABT?

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One of my pts pulled out his PICC Line yesterday night. When I got in today, the AM nurse said he had it done and PICC is back on. When I was to start next dose of ABT, no PICC line found. I called Supervisor. She called another nurse who IV certified started Peripheral IV for temporary. Well, I am a new nurse I did not know it is not practical to use Peripheral IV for ABT such as Vanco. I used it for Piperacillin. Anywhere, the third shift got pretty upset because she learned that the pt did not have PICC and she has to hang Vanco. She said pt could lose his arm for that. I did not know what to say. All I could say was it was not my call, it was the supervisor who went a head with this plan. Who is to blame at this point?! The AM nurse who claimed pt had it or me and/or the supervisor? Somebody is going to get their tail chew for this I think.

Specializes in PACU.

Peripheral administration isn't ideal for vancomycin, but it's acceptable, especially in the short term. Assess the IV site pre- and post-infusion and instruct the patient to report discomfort during administration.

Specializes in ER.

We give Vanco in a peripheral IV all the time in ER. If it's a tenuous site, like a LOL, or a small vein/gauge, we just run it a tad slower and warm pack if needed.

Specializes in orthopedic & HDU.

We give Vanco via peripheral line daily, not the best but it's legal. You just have to run it a little slower and with lots of observation to the periphery. In regards to who to blame. My thought would be you. Nursing supervisor. Are there to give you support and advices and recommendation. But it's is you that responsible for your patient total care. But I don't think this will proceed to " who to blame thing".

Since I am new she suppose to look over me. She made the call and had another nurse started the IV and written MD order. The unit is so busy that she has to jump in to help. But I understand what you mean. Now I've learned it is completely legal as long as you run it a little slower. But this nurse who knows how it works made it sound like the pt's arm was going to fall of the next day. She made a big deal out of it. The thing is that there is no way we can get the PICC done. Pt has multiple ABT and has to get it on schedule. In my opinion, the person to blame is the AM nurse who told me pt has PICC and the matter is there was no PICC. I checked the pt's arm right after I started the shift and immediately called the supervisor so we could do something about it to start his 6pm dose. We had to run it an hour earlier in fear he would pull it again.

I am not yet a nurse but I do work for an IV company.

Our policy is that if a patient repeatedly pulls out PICC lines, then it is UNSAFE to place another... we usually give it 2 or 3 times depending on the patient. If the patient pulls out a PICC line, it could break off and cause serious damage. When it happens, we recommend an x-ray to verify there are no fragments left behind and we also measure the line to make sure it is the same length as when it was placed.

There is no issue with running antibiotics through a PIV. It obviously isn't for long term use, but it is okay temporarily until a PICC line, port-a-cath, or indwelling central line can be placed. We often place peripherals at night for antibiotics because we do not place PICC lines after certain hours. I agree with the above posters though, it must be closely monitored because vanco is a vesicant drug. Also, vanco should NEVER be ran through a midline....some nurses do not understand that running it through a midline leads to patient's losing their arms because you cannot see it infiltrate as you can with a peripheral. Midlines are viewed as "safer" when in reality for certain drugs, they are not!

Hope this helps! :)

Specializes in Oncology/Haemetology/HIV.

I have run Vanco 100s if not 1000s of times via PIV.The big thing is to notify pharmacy whether to mix as peripheral or central concentration.

Specializes in ICU.
I have run Vanco 100s if not 1000s of times via PIV.The big thing is to notify pharmacy whether to mix as peripheral or central concentration.

Me too. Never, ever an issue.

Specializes in Pedi.

I would say I give Vanco through PIVs more often than I do through CVLs/PICCs. The vast majority of IV antibiotics on my floor are given through a PIV. It's only when a patient is going to need long term IV antibiotics that they'll get a PICC line. If they are Onc patients then they already have CVLs but there is nothing wrong with giving Vanco through a PIV. It is a vesicant and I've had it infiltrate on me before and the infiltrate resolved without issue.

Specializes in PCU.

Ideally you want a PICC for Vanco. If you have PIV, you want to ensure patency, run slower than normal, and check frequently to catch early infiltration.

Over the last few years we've been increasing Vanco through PIVs. Still makes me nervous, but close monitoring and educating the patient as to what to report helps keep them safe.

I've given vanc through an PIV. If that is their only line then I use it and just monitor it as I would when infusing anything. Sounds to me like you came across an anal nurse who pitched a hissy for no reason. Sorry that you are so stressed out over it, I hope it gets better.

Specializes in NICU, PICU, PACU.

We give Vanco per PIV all the time in our unit. When a kid gets a sepsis, most of the time it is line related and we have to pull our PICC or Broviac, then we give the Vanco peripherally until ID says we can insert another long term line. I have seen a few infiltrates from it unfortunately, but there is nothing contraindicated about it.

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