Running amiodarone through the proper line

[Keyley]

I am a relatively new nurse, and new to cardiac nursing. I had a terrible experience this morning when an older nurse berated me during report for using a patients VAP to run amiodarone. The patient was in rapid afib and did not tolerate his cardizem gtt in the ER so when admitted to the floor there was an order for amio gtt. The previous RN ran it through the only access we had, his VAP. She later obtained a peripheral line for his antibiotics and potassium infusion. The patient had stg 4 cancer and received chemo last a week ago. When I took over, I left the lines running as they were, as I felt it made sense for the amio to run through the largest most central line possible. I did contact the doctor to get an order for ok to use the VAP for line draws. In the morning the nurse told me "oh my god, I can't believe you guys polluted his VAP with amio, you know you can't use a line again after it gets amio" she is also our nurse educator. I felt about a foot high. She said she would talk to the doctor about it. Anyways, can't stop thinking about it but I haven't been able to find any literature that says it will "pollute a port" and preclude us from continuing to use it for chemo if needed. Any input?

[chare]

First, I'm sorry that this happened to you. As your unit's nurse educator she should have taken the opportunity to educate you on why you shouldn't have done this, rather than belittle you during report. When you get a chance, ask her for the rationale for not running amiodarone into an implanted port (I assume that's what you mean by VAP).

I work in PICU, and we rarely run amiodarone. However, when we do it is never through a dedicated line, and we continue to use the line after we discontinue the amiodarone infusion. As the patients that do are mostly post cardiac surgery, this is usually through a temporary central venous line, however after running amiodarone we don't discontinue using the lumen. I can't imagine that infusing through a port is any different as long as you flush with whatever volume the manufacturer recommends after discontinuing the infusion.

You might try posting this in the Infusion Nursing/Intravenous Nursing forum for better response.

[JettRNurse]

Sounds like she is a grumpy/rude nurse. I'd like to see the evidence backing up her claims, I've never heard of such a thing.

[Esme12, ASN, BSN, RN]

moved for best response. I have not heard of avoiding the port or that it is no longer usable after amiodarone.

[thenightnurse456]

I agree with the above, a nurse educator should have taken to opportunity to EDUCATE- not belittle you.

[MzAmerykah]

I too am sorry to hear this nurse acted in such a manner. Don't let her attitude get you down. We were all new at some point and we are all still learning. Perhaps once you find the answer, you can educate her.

Was the Amio connected with an in-line filter? The manufacturer recommends a filter because precipitate develops quickly when Amio is mixed with IVF. Perhaps that is what she meant by polluting the port. Here is an article I read regarding the incidence of phlebitis when it is administered peripherally, which is why it is better to administer it centrally as you mentioned: http://ccn.aacnjournals.org/content/32/4/27.full.pdf