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Discussion

PIV Vanco administration

I am a nurse at a Family Medicine clinic. It is also a residency program affiliated with a University Hospital with many resources, including an infusion center. Today I was asked to give a patient IV Vanco 1 gm via PIV. I haven't been working at this clinic long, about 8 months and have only given Vanco via PICC with an infusion pump. So, I find out that there is no infusion pump and this would need to be given after calculating drip rate. Then I'm given a vial of Vanco powder from our pharmacy who had to special order this and find that there is no package insert and the pharmacy does not make the bag. After that, I go to look at our IV supplies and find that we only have 1 liter bags of fluid and I would have to withdraw the extra fluid from the bag before adding the reconstitued Vanco.

Now, it is pretty obvious to me that this clinic is not at all equipped to handle this situation and this is poor patient care, especially with a top notch infusion center available. I told the ordering provider that I was not comfortable doing this and asked for this procedure to be set up at the infusion center. I definitely caught some heat today, but bottom line I felt this was a huge patient safety issue, not at all best nursing practice and I believed it was the right thing to do.

Please tell me your thoughts and if any of you would have given the IV Vanco under these conditions (keeping in mind you have an infusion center available to you) Maybe I was just spoiled in the past.

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    • Featured Replies

    My thoughts are there is no way in **** I would have given it either.

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    I have to agree with the previous post on this. You did the right thing.

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    You might ask that ? of 10 different nurses and get 10 different answers! The important thing is that you trust your own judgement and happily, that is what you did today. As your level of experience grows, you may or may not change your response if faced with a similar situation in the future. I am surprised pharmacy didn't give you a little more direction. If I was going to give the vanco (theoretically speaking- I'm not saying I would have in your particular case), I would have requested the pharmacy to mix up the bag-that's their job for heaven's sake.

    Don't sweat it, you did well...

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    I would not have given. I agree with Vanrn, isnt that what the pharmacy is there for??

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    • Guides

    Depends - in Australia where I trained, we made up our own infusions of everything all the time. I probably wouldn't have been happy with the 1L bag though - you'd be giving it in what, 100mls you'd have to ditch an awful lot.

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    • Author

    A friend of mine (who has been an RN for ages) and I discussed this last night as well and what I told her is that what really bothered me is that not one step in the process was a good way to do it. So lets say I had an infusion pump and the right bag, I could get by with having to mix it myself, not a problem I've done that before. What bothered me the most was why even put that patient through that and expose them to potential harm when we have a perfectly good infusion center about 10 minutes away from our clinic. In addition, the provider never even asked the patient what she would like to do. If I was the patient, I would certainly have chose to go to the infusion center.

    I am going to see if I can find a policy or procedure regarding this today. Will keep you posted.

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    I don't know if what we do is right or wrong. Occasionally pre-operatively a surgeon orders Vancomycin IV. I don't have our guidlines in front of me, but we have the recommended dilution ratio posted, we give it using a pedi IV drip tubing, (60 gtts/ml) and just moniter it visually (we don't have any infusion pumps,) run it in over an hour. We mix it ourselves. I work in an out patient surgery center.

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    In hemodialysis, Vancomycin 1 gram is ordered pretty often and the mixture of the dry Vanco with the IV fluid is done by the RN's and the rate is always ordered to be infused over one hour. We calculated gtts per minute (no infusion pumps) and monitored the pt and infusion rate throughout. Granted our infusion sites are either the veinous access of the fistula or the veinous port of a central line, which made it easy, as we knew the access was patent. In dialysis you have to give Vanco after the pt has completed their treatment or you'll dialize it out. The dry Vancomycin bottle comes in a box that has an insert that covers everything about the drug. I've worked many times in hospitals where there were Infusion Pumps, but they ran short, so I had to use gravity and gtt factors. Being a Cardiology Nurse for the past 8+ yrs Infusion pumps are required. :rckn:

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