vanc given peripherally

flightnurse2b, LPN · Dec 2, 2007

Hi I recently had a pt. getting vancomycin through peripheral IV's. She was a very hard stick but someone managed to get one in her hand, and they weren't going to be able get a PICC for her for a few days. So, I hesitantly gave her the vanc through her hand IV and to my horror, it extravasated and her hand was swollen three times it's normal size. I took out the IV and elevated it, but now I'm wondering-what are the chances that this pt. is going to lose her hand or suffer major damage? Does this happen often? I'm so worried.

i would definately call the MD! the patient needs to be monitored since vanco infiltration can cause serious tissue damage and necrosis. heres a good article on infiltration to check out:

http://www.nursing2004.com/pt/re/nursing/fulltext.00152193-200208000-00044.htm;jsessionid=HStLXyrrJKJznGDCJvph7W14021G0XBx1hyxkByp4vLH9L1Rm4FM!-1601909834!181195629!8091!-1

lenleo · Dec 12, 2007

Hi, I'm new and came across your comment on vanc given peripherally. I'm still in school, but I have a friend who has a patient with a problem. She says that her (the patient) doctor is in Atlanta Georgia and she lives in Texas. In order for her to start her vanc therapy, she needs a dr. in Texas (Houston) to give an order for her vanc therapy to the nurses agency (in Houston) because they don't accept dr.'s orders from Atlanta Georgia. Does anyone know a doctor that deals with PICC Lines or knows vanc therapy that she can go see???? Remember, she is in Houston, Texas. (very confusing!)

txspadequeenRN, BSN, RN · Dec 12, 2007

i had a patient once that (not to long ago either) that had a peripheral iv and had a series of vanc ordered. i questioned it and was told it was ok for short term therapy. so i proceeded and all turned out well.

ukstudent · Dec 12, 2007

Hi, I'm new and came across your comment on vanc given peripherally. I'm still in school, but I have a friend who has a patient with a problem. She says that her (the patient) doctor is in Atlanta Georgia and she lives in Texas. In order for her to start her vanc therapy, she needs a dr. in Texas (Houston) to give an order for her vanc therapy to the nurses agency (in Houston) because they don't accept dr.'s orders from Atlanta Georgia. Does anyone know a doctor that deals with PICC Lines or knows vanc therapy that she can go see???? Remember, she is in Houston, Texas. (very confusing!)

We can not give out recommendations here at allnurses.:welcome:

lenleo · Dec 12, 2007

:bugeyes:I apologize. I'm new.

iluvivt, BSN, RN · Dec 13, 2007

of course you can give vancomycin peripherally. There are very few things that absolutely must be given in a central vein. For example, TPN and continuous vesicant chemotherapy). Then there are things that are optimal for example,amiodarone and dopamine.If I were giving vancomycin peripherally I would locate a soft large vein away from an area of flexion and with good tissue around it, I would generally avoid the hand because when vancomycin with its low ph ( ABOUT 2.3) infiltrates here there is not a lot of tissue in the hand and there could be nerve damage, tissue necrosis and functional losses. Also use the shortest,smallest catheter that will meet you needs (improves hemodilution). The next thing that needs to be evaluated is the length of therapy, ph and osmolality of the drug or infusate,current status of the pts veins and can they safely support the prescribed therapy,age sex, dx and any comorbitities present. If the PICC line was needed why could it not be placed sooner. Maybe this a problem that needs to be looked at. The MD could have also placed a percutaneousely placed CVC until the PICC could have been placed. Prevention is the best. Once infiltrated/extravasated initiate thermoregulative treatment,notify MD, pt teaching, monitor CSM,follow your policy and keep monitoring. Sometimes damage shows up weeks later. that is why teaching is so important. Do not forget to document all youe efforts