I am very well aware of the risks of vanco. But for every picture you can find, there are 10 LTC facility residents that get 1-10 doses via PIV or midline without any problems. This makes me look like a pain in the ....when I tell the nurses to request a PICC or call the MD and ask for a PICC order. As you all recall, I am the one who advocated for INS standard 37 on this list based on the fact that I have seen a line placed in the wrist called a PICC and Vanco infused through it for 2 weeks, the pt had a phlebits, but no blistering or sloughing(luckliy)
This is when I said----no, you cannot give Vanco through a piv, and that started others moaning at me for that statement.
I am aware, as I am sure all of you are, that although a central line is best for Vanco, very often it is given via PIV in the hospitals, and via PIV and midline in the LTC facilities.
I have gone as far as to call an MD, and argue INS standards with him, and he said to me"they do it that way in the hospital all the time....and who is the INS? "
I told the nurse the pt needed to be sent out for a central line placement. The next day , I was back at the facility to see a different patient, and checked on the one from the day before. She had a midline. Apparently, the staff called the pharmacy, who sent out a different nurse, who placed the midline as ordered.
I am not saying, nor have I ever, that a midline is good for vanco. Just that it happens, due to lack of nurse education, apathy, lack of MD education, costs, etc.
But, for hydrations and antibiotics with a pH 5-9, it is a great idea, especially in LTC and homecare where orders do not change on a daily basis, and there is consistency among caregivers.
Chris Cavanaugh, CRNI
----- Original Message -----
From: Bev and Tim Royer <[EMAIL PROTECTED]>
Date: Monday, February 6, 2006 2:04 pm
Subject: RE: RE: Midlines
To: [EMAIL PROTECTED]
> Hi Chris,
>
> Some patients do seem to tolerate it, others not.
> Attached is a picture of a Vancomycin extrasavation. This patient
> came to
> us from another facility that had a short peripheral IV in his
> upper arm
> cephalic. Patient did recover after 4 months without the need for
> plasticsurgery.
>
> Timothy Royer, BSN, CRNI
>
> You may use the picture for educational use if you would like.
> Howeverpicture may not be used in publications of anytype.
>
