Many doctors at my facility have been asking me about the length of time a vesicant can run peripherally before they should be ordering a central line. As I told them I have never really heard of any specific guidelines I will look into it.
I have told them that vesicants can run in a small gauge IV in a large vessel prior to obtaining central access. That access must NOT be in an area of flexion unless there is an arm board to support and it must be assessed frequently. Blood return check must be done prior to infusion.
Our facility does have an IV Team that starts all peripheral lines in house except procedural areas. We maintain all lines on the floors in the hospital. We are looking to go over to a better notification to the team when a vesicant is ordered.
Thank you for your time in advance~
I have read the position paper that states:
i. Patients receiving intermittent infusions of vesicants
The nurse should advocate for central vascular access administration of vesicant medications whenever possible. The peripheral infusion of vesicant agents should be limited to less than 30 to 60 minutes.10,11
but was hoping for more information from other facilities.
Thank you~
Joy Selchow RN, BSN
Nurse Manager
IV Therapy Department
Can you post the reference information for that time? I have never seen anything like this in the literature. I know it is not from the Infusion Nursing Standards of Practice. the goal is ASAP to get the CVAD in and stop the peripheral infusion. There is no specific time where it is "allowed" or recommended. 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
I read it in the below position paper from INS.
http://www.ins1.org/i4a/pages/index.cfm?pageid=3412
INS Position Papers
Recommendations for Frequency of Assessment of the Short Peripheral Catheter Site (07/05/12)
Joy Selchow RN, BSN
Nurse Manager
IV Therapy Department
Thanks for the reference. This statement is under the heading of how frequently to visualize the site, More frequently - At least every 5 to 10 minutes for vesicant infusions. When I read the original message, I thought about continuous infusions of vasopressors, etc. It is unreasonable to think that a busy ICU nurse will be assessing a PIV every 5 minutes when a vesicant is infusing. I don't think this position paper intended to have this statement used to establish the recommended length of time for infusion of a vesicant. But it does allow for using PIV for short vesicant infusions such as those infusing only for 30 to 60 minutes. 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 Lynn~
I have told the doctors the sooner the better but if I was able to give them facts/data they would be happier. Can't please everyone.
We unfortunately have quite a few delays for central access at our hospital. MDs stating only another 24 hours when that was what was said 24 hours ago. Our IV Team advocates for the patient every day but it may still take 4 or 5 days to get a PICC order. We now have a team put together of CCU intensivists, pharmacy and IV to close this communication gap and overalll delay. Some MDs state the complications of a PICC do not out way the complications of running peripherally. Our PICC team now has over a years worth of data on all PICCs placed and % of complications (occlusion, DVT and soon infection rates). I find the more knowledge they have the more understanding and cooperative everyone is.
Joy Selchow RN, BSN
Nurse Manager
IV Therapy Department
Outcome data is what is takes, along with the interdisciplinary collaboration. Please consider publication of your process and outcomes. 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
The Oncology Nursing Society indicates in the 2009 ONS Chemo/Bio Guidelines that vesicant chemotherapy infusions via PIV should run no longer than 30-60 mins. p. 102.