Who gets the write up?

Both.

In theory, it should be the overall situation that "gets" the right up, not specific people, but if you were to identify responsible parties it would be both nurses, the MD, the facility.

Just as concerning as the bad infusion set-up is that a patient on max pressors with apparently only one peripheral IV site wasn't going to get a central line for "a few hours".

For any drips, we use no port lines to prevent this. Also, when we switch from perioheral to central lines, we make up completely new lines. I would say both nurses are at fault

I'm trying to picture this...so did the patient get the central and had levo infusing to that AND as the primary on the peripheral site or still the peripheral and the patient went without levo the whole time the vanco was infusing?

I agree with the situation as a write-up. Why did you have to wait "for hours" for a central line? That's crazy. You or the nurse who hung the Vanco could have caught the error, but also the oncoming should have checked his/her patient's lines and it could have been caught then.

Thank you to everyone that commented. I agree, both get the write up. We are a very small community hospital and do not have lots of options or physicians available for central lines. We rely on a PICC line service to do this for us, so it is typical to wait for a few hours for the central line. If needed we do IO's to get us by. I was trying to avoid that. And to smf093, the patient had levo infusing through one site only which had a dual port connector with the main line connected to the other port. To add a little more to the story, the patient was 99 years old, a DNR and ended up passing away later that night on the night shift.

It was poor staffing, as usual, with a total of 2 RN's, no free charge nurse. We started with 3 patients , got a floor transfer in, transferred 1 patient out and got an ED admission. Certainly, NO excuse though.... Anyway, I really appreciate all the feedback. Lessons learned by all that day.

So many things gone wrong in this situation. Levophed maximum dose in a peripheral IV? Really? That's got to be nearly 90 ml/hr infusing, a super high dose.

The correct thing to do would have been to start an additional IV for better access, even if it required ultrasound guidance.

The primary RN should have been written up for allowing that to happen in the first place. If it was a super edematous patient with difficult to find veins, tell the provider. Make the central line an immediate priority. Or at least get a verbal order that Levo in a PIV is temporarily acceptable. I think the primary RN could have handled this much better.

That is confusing...most central lines are at least a double if not triple lumen. So you could have levo and vanc running in their own primary lines. There shouldn't be any mixing of them, because while vanc is running as a piggy back, none of the levo is running (for 60-90 minutes I presume). And then I have no idea if these two drugs are even compatible with each other, is the other issue.

If it was a single lumen central line, that was a poor judgment call by the provider or PICC team because any patient on pressors is likely needing a bunch of other things at once. And the pressors cannot be interrupted. There are several things wrong here.

There are several things wrong here.

Understatement of the thread.