Has anyone had any problems with Rifampin being infused through a PICC line in their pediatric patients?
I stopped by the PICU today, making rounds, and one of the nurses asked me if there was a problem. She was instructed by the ID doc not to give Rifampin through the PICC line because it would "mess up" the line. Of course, no rationale was offered. The only thing I am finding on the net is that some people have reported percipitate problems as the issue. It also appeared that the posting nurse was talking about a PICC line in a neonate which would be much smaller than the 5fr I have in my PICU patient.
I quickly checked the Intravenous Medications, book by Gahart and Nazareno. There is almost no information on compatibility with other drugs in the rifampin monograph. Since these patients are in ICU, I would suspect that there are many other drugs being given. Are you placing dual lumen lines in these patients? If not, I think you are seeing drug incompatibilities forming precipitates inside the lumen. Rifampin has a pH between 7.8 and 8.8, so contact with other solutions could easily be dropping this pH and causing these precipitates. The physician stating that this drug messing up PICCs is probably correct but you can not stop with that brillant, scholarly opinion :). Sorry don't mean to be cruel but the comment did not help matters. I would go to the pharmacy and seek their help on getting more advanced information about the compatibilities of rifampin. I would also immediately instruct the nurses to avoid having this drug make any contact intraluminally with any other drug. And I would start placing dual lumen catheters. Lumen size of the catheter does not matter when it comes to precipitate formation. It is a change in pH that causes this so all contact between drugs must be avoided. 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