Hello, I was asked a question by the pharmacy interns here at our facility. They were wondering about the allowed rate of infusion for peripheral i.vs. I went into the whole deal of differnt drugs and different rates due to ph, osmolarity etc as well as iv sites ands discomfort., sites etcc for irritants, etc.... This wasnt really what they were wanting. They want to know is there a recommeded rate of infusion for a peripheral site; such as if you have a large bore i.v. in the arm can you run the antibiotic any quicker than a small needle in the wrist, or if you have a PICC or a port can you run it quicker vs a small peripheral iv in the hand. Pharmacy seems to do a generic safe flow rate for all meds and are wondering if there is any guidelines to follow related to peripheral veins or site selection. .
I also discussed that different veins have a different flow rate of blood in them versus others, but that didnt seem to be the answer either.
I really just said for the Vanco for example it is the drug itself that people have reactions to , as well as it being a vessicant. I would not recommend it being infused any faster even if you had a central line with great hemodilution.
For other ivpbs I would not know, I would say it would have to be according to manufactors recommendations. Do you ever run anything quicker since you have a PICC line??
thanks in advance, Gina Ward R.N., CPAN
There is no such rate and I really do not understand why they are trying to create this. There is no such thing as a safe generic flow rate. You will find lots of data on max flow rates in the catheter instructions for use. These rates are done in a lab using a standard fluid such as NS with the bag at usually 39 inches (1 meter) above the catheter - to represent the typical distance between the patient and fluid container. Max flow rates are determined by the size and length of the tubing and catheter used for infusion. A 20 g short peripheral catheter will allow a much faster flow rate than a PICC with the equivalent internal diameter. Safe flow rates are determined by each drug - just look at the rates listed for each drug in a book such as Intravenous Medications. Peripheral veins can tolerate rapid infusions of liters per hour - example massive trauma requiring fluid resuscitation. There is one study from many years ago that found a lower rate of phlebitis when the med is infused faster over a shorter period than when it was infused slower over a longer period - sorry don't remember the reference. RE peripheral vein site selection - there are numerous factors involved in that decision but they do not necessarily include a different flow rate simply because you are infusing through peripheral veins. The rate for each drug is the recommended rate from the drug manufacturer and this is not determined by the type of catheter or vein being used. There are some meds with recommendations for infusion through a CVAD due to their vesicant or irritant nature. This is due to the larger faster blood flow in the SVC comparing to a peripheral vein, producing greater hemodilution and reducing the risk of vein trauma. Not sure if these thoughts are helpful or not, but I think there question is a little strange. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Thank you for your response. I am glad to see you thought that was a weird question. I think they were responding to nurses who give the meds in OP and want to see if they can give it a little faster to get the patient out quicker.
Thanks again, Gina
Gina Ward R.N., VA-BC