vancomycin and peripheral iv's

Yes, you can give Vanco using a PIV, both in adults and neonates. My Nursing Drug Handbook states IV use, no mention of central lines.

CAN you do so? Sure,it's done all the time. SHOULD you? That's a little different. When deciding if a med needs to be infused centrally or not,one of the considerations is the pH of the solution. Very high (alkaline) or very low (acidic) pH solutions should be given centrally. If given peripherally,there is a high risk of damaging the inner lining of the vein and causing phlebitis or thrombus. Vancomycin is one the more acidic drugs out there,with a pH of 2-2.2,no matter how it's prepared. For comparison,the pH of normal stomach acid is 1-3.

PICC/ Central line is the preferred route; peripheral is accepted if necessary. Administration via midline is not an acceptable route. Will try to find the source for you; these recommendations came from an IV CE course I took a couple of years ago.

Reference for the above is the Infusion Nurses Society standards of practice from 2006. "Therapies not appropriate for peripheral-short catheters include continuous vescant therapy,parental nutrition,infusates with pH less than 5 or greater than 9,and infusates with an osmolality greater than 600 mOsmol/L."

totally agree with PICC ace . Do not delay a dose while waiting for a CVC. Start a PIV then secure an appropriate CVC as soon as medically feasible. Plan ahead and if you know patient will require abx for awhile request a PICC be placed to preserve the peripheral vasculature.

I have found that the facilities where I work you have to pull teeth to get a PICC even after trying to rationalize with them that the patient will require a harsh med over a long period of time.

Had an incident just last night over PIV infusing Vanco on AM shift, site very, very edematous, red, hard, and painful to resident. Pulled line, started another, wrote incident report, talked with DON, and of course, since this was an incident involving one of the pets, was told "just do not let it happen again." WHAT!!!!!!! I found the mess, I did not create the mess, I had been off and this was a new resident to me. Even in resident who have ports and other devices, this facility wants an Act of God to use them. Just another reason why I am looking for a new job.

The Infusion Nurse Society standards indicate that meds with a high pH or very low pH should not be infused peripherally. That would be pH 9.0 or with osmolarity >600.

www.ins1.org (I think)

We do give Vanco via a PIV but I hate doing it. I remember a time when giving Vanco was a major event and it was a medication that was rarely used. At that time, it had to be infused via a central line. I frankly don't like infusing it via the PIV route.

When I was in medicine we would generally plan to get a PICC placed if a patient was found to need Vanco by ID--they were usually the docs seeing these infections that were resistant to other ABX-- they would tell us it was okay to give a few doses via a peripheral line but generally the nurses would be nagging the docs saying--Hey...this patient has been on Vanco for 2 days or 3 days or whatever and hey did you want to go ahead and get a PICC put in? Sometimes they woudl forget so we were kinda the ones making sure they were aware the Vanco was still going through the ordered Peripheral. I found that they usually would be appreciative of the reminder and say...oh yeah, you're right why don't you go ahead and call the PICC team and I'll write that order!

So there the nurses were pretty on top of that-- Vanco is hard on the veins so giving it for too long via a peripherial line can cause some pretty nasty damage. A few doses is okay.

I remember having to hang a loading dose of IV vancomycin for one of my patients. It was to be run over 90 min, though I like to run it longer than that given it is so irritating to veins...so I made sure the IV was patent, hung it, came back after 45 min and unfortunatey I could tell that the IV had gone interstitial. His arm was a bit puffy and red, looked painful though the patient denied any discomfort. I immediatley discontinued the IV, started it on the other arm and ran the rest through without problem. Though I have to wonder, given that this was the loading dose, would this scew the next vanco draws? I was assured from collegues that it shouldn't as most had infused. Poor guy, I hope that the swelling and redness goes down HATE PIV Vancomycin!!

It is commonly given in PIVs on my floor.

Someone on the vascular access team at my hospital taught me that, if you have a choice, you should pick the SMALLEST PIV for Vanc. So, if the patient has an 18 and a 20, you should run the Vanc through the 20. This is the opposite of what I would have assumed. However, he explained that smaller IVs have more blood flow around the catheter and therefore the Vanc gets mixed up and diluted with the blood faster and you decrease your risk of damaging the vessel (compared to a bigger PIV that doesn't have much blood flow around it).