Re: [vascular] Vanco infiltration

[Lynn Hadaway]

Title: Re: [vascular] Vanco infiltration

It sounds like you are between a rock and a hard place, as we say in the south. But I would encourage you to continue to work as a patient advocate. Stick to your position on this one!

I have not been able to locate any published articles that discuss a case of extravasation injury from vancomycin, but I have served as expert witness on such cases.

Here is what I have.

This is a review article on Vancomycin:

1.      Hadaway L, Chamallas S. Vancomycin: New perspectives on an old drug. Journal of Infusion Nursing. 2003;26(5):278-284.

This one discusses the chemical causes of infusion phlebitis:

1.      Robibaro B, Vorbach H, Weigel G, et al. Endothelial cell compatibility of glycopeptide antibiotics for intravenous use. Journal of Antimicrobial Chemotherapy. 1998;41(297-300).
Vancomycin is a glycopeptide antibiotic.

A few others:

1.      Tagalakis V, Kahn S, Libman M, Blostein M. The epidemiology of perpheral vein infusion thrmbophlebitis: A critical review. American Journal of Medicine. 2002;113:146-151.

Effectiveness of pharmacy policies designed to limit inappropriate vancomycin use:  a population-based assessment       A. Thomas, P. Cieslak, L. Strausbaugh, D. Fleming       Infection Control Hosp Epidemiol        pharmacy policies, inappropriate vancomycin use, population based assessment    03-23-05        Volume 23, Number 11, November 2002     683-688 4613    Clinical Study

Clin Pharm. 1988 Oct;7(10):720-1. Links
    Phlebitis associated with vancomycin therapy.

        * Garrelts JC,
        * Smith DF Jr,
        * Ast D,
        * LaRocca J,
        * Peterie JD.

    PMID: 3233894 [PubMed - indexed for MEDLINE]
    Related Links

     For promethazine, the most recent, and I think the most powerful, resource is from ISMP and can be found at:

Action needed to prevent serious tissue injury with IV promethazine
http://www.ismp.org/Newsletters/acutecare/articles/20060810.asp

Your patients needed your continued attention to this problem! Lynn
 

At 9:25 AM -0600 8/15/06, Autym Didsbury wrote:

Hi all-
 
I am coming to the group for a couple of suggestions.  We continue to
get tremendous pressure from physicians to give peripheral vancomycin,
phenergan, and other potentially dangerous meds.  In addition, the
"powers that be" at our agency are not supportive either- we are
basically told to take whatever is referred for fear of "alienating
referral sources."  (Yes, I know)  To further complicate the situation,
I am not getting a lot of support from my infusion pharmacy either- they
are GREAT, but complacent with the issue of peripherals despite the
potential risk.  Our "risk management" person is not a clinician, and
doesn't grasp the implications at all.   What I am looking for is any
references specifc to vanco infiltration and potential complications, as
well as information regarding treating various extravasations.  Any
suggestions would be greatly appreciated.  The concept of appropriate
vascular access planning has not gained much ground in this community,
and I am hoping that it doesn't take a disaster to get everyone's
attention. 
 
Thanks as always-
 
Autym Didsbury, RN, BSN, CRNI
Home Health Manager
Partners in Home Care
2687 Palmer St. Suite B
Missoula, MT  59808
(406) 327-3717  Fax 327-3727
 
 


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-- 

Lynn Hadaway, M.Ed., RNC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
http://www.hadawayassociates.com
office 770-358-7861