propofol infusion ONLY through central line

cardiacRN2006, ADN, RN · Oct 17, 2006

A new critical care MD in our unit ordered diprivan per short term sedation protocol ONLY through a central line.
When I asked him about it, he said "none of MY patients will receive diprivan through a peripheral line;it'll eat their vein up". He is the only MD that has stated that. If the pt. has a central line then we use it and if they're on TPN we y it into that. But many of the pt's we have we use a #20 or #18 peripheral to infuse diprivan without problems.
Any comments on this would be appreciated!

Never heard of that. I tend to save my ports for dopamine or K runs rather than propofol. I certainly have used proprofol on #20s and it did just fine.

jmgrn65, RN · Oct 17, 2006

I would have said well then you better put one in, what size gloves will you be needing.

I have infused diprivan many times via a pheripheral vien.

sunshineCCRN · Oct 17, 2006

A new critical care MD in our unit ordered diprivan per short term sedation protocol ONLY through a central line.
When I asked him about it, he said "none of MY patients will receive diprivan through a peripheral line;it'll eat their vein up". He is the only MD that has stated that. If the pt. has a central line then we use it and if they're on TPN we y it into that. But many of the pt's we have we use a #20 or #18 peripheral to infuse diprivan without problems.
Any comments on this would be appreciated!

We can give it peripherally where I work, but if I have a free port on a central line, I'll use that. Think of all those outpatient procedures that use a profpofol gtt! I doubt anyone would start a central line for those! :chuckle

I always wondered about propofol's compatibility with TPN. I feel like there's too many ingredients in TPN to know if the two are truly incompatible--and it would be nearly impossible to detect a precipitate.

TopherSRN · Oct 17, 2006

If a resident or himself will place a CVL for the propofol then whats the problem? I know I'm spoiled being in CVI but I absolutely hate peripherals now. Sure propofol can infuse through a peripheral, but if that doctor insists on a CVL then hes ok in my book.

I've seen TPN and Propofol run together very often. If I have a free port(which usually happens between the CVL, Cordis, and Swan) I'll run them seperate but in a pinch I've had propofol, TPN and KCL, Mg, and Ca running together.

RoxanRN · Oct 17, 2006

We've run propofol peripherally (even with a 22ga) and never had a problem. We rarely run it with anything other than NS.

It's also our policy that TPN runs in a dedicated line (but this isn't what the OP was asking.... :) )

dfk, RN, CRNA · Oct 18, 2006

it seems to be quite an invasive procedure just for propofol. however, if the pt is intubated, will probably get sicker, and need the central line for fluids, abx, etc... propofol becomes extremely basic in the blood after prolonged infusion, with a pka of 11, and rather irritating to the vein, especially in the smaller vessels. most pts cannot express their discomfort because they are anesthetised with said drug. by the time they are awake and extubated, the propofol is off. one thing that can be done is infuse a bit of 0.5-1% lidocaine prior to infusion to help numb the vessel. some literature follows a propofol-lidocaine mixture infusion, again using low-dose lidocaine.

mrsituation · Oct 26, 2006

diprivan only through a central line...Seems kinda extreme to me. According to our pharmacy dept. and the literature that I have read--no such evidense to require diprivan to be infused via a central line. Although on our unit, it is our policy to not run diprivan with anything else, so rather than dedicate a central line lumen just for diprivan, I personally tend to dedicate the peripheral access sites for that especially if I have a lot of infusions running, we also change diprivan tubing Q shift...(12 hr shifts).

glasgow3 · Oct 26, 2006

At one time the Society of Critical Care Medicine (SCCM) guidelines for propofol infusion specified the use of a central vein. In 2002, however, a revision was made which did not include that requirement; the revision did include mention of a dedicated line.

I do not believe there is evidence to support a requirement of central line placement for short term propofol infusion.

APNgonnabe · Nov 2, 2006

This is coming from a less experienced student BSN, but I work as a tech in a large ICU. I assume that you all have done research because that's what good RN's do...which leads me to saying I trust what has been said, however, has anyone seen propofol infiltrate? I saw it once and it was ugly. Maybe that's his reason (not stickin up for the doc).

LEVODEVO · Nov 2, 2006

Hi,just had my 3rd OR procedure where propofol was used for a pre-op prep,all peripheral,who the heck's gonna place a central line for one of the most popular pre-op meds used today?....had a bunch of dental work done...oral surgery....propofol....worked great...and certainly no central line from the dentist..I use it like candy in my ICU and we're spoiled with dentral lines,but if the central lines get crowded and they do...propofol will be one of my top pickes to change over to periperal due to it's safety....hope this helps....hey Docs choice,who knows what he heard or saw and now is scared of propofol....my guess it was something piggybacked into propofol that he didn;t knwo about that did some damage...just a guess...

augigi, CNS · Nov 5, 2006

To the poster who asked what's the problem - the problem is that a CVL is an invasive procedure which carries many risks, including massive infection, embolus and death. To put one in just for a propofol infusion, which is neither recommended by ICU protocol nor by the drug manufacturer, with no evidence, is bad medicine.