Following the Infusion Nurse Society guidelines, Hypertonic saline should be infused through a central line. I am getting push back from pharmacy saying a greater chance of a complication would be a CLABSI because a central line was inserted for this short term therapy. Any guidance you would have would be great. I have done the lit search and of course the articles I have found say it’s short term and can be infused via a peripheral IV with diligent monitoring. Looking for a nursing suggestion.
Thank you,
Sherry Herbert RN, MSN
Infection Preventionist
Our Stroke team has our Vascualar Access Team on speed dial for Power Injectable PICC placement when HTS in needed...
In using the INS standards, please note that the use of the word "should" is seen in the Practice Criteria sections. A peripheral catheterr should not be used for infusion of pH----- you know the rest of the statement. This is not an absolute mandate to never use a peripheral or midline catheter when the pH and osmolarity fall outside of those parameters. This statement is never intended to remove the nurses responsibility to assess risk vs benefits for each patient. The risk of CVAD insertion vs the benefits of no CVAD. The risk of peripheral infusion vs the benefits of peripheral infusion. 3% and 5% sodium chloride should NEVER be accepted as an open-ended prescription. There should be some indication as to a specific quantity or specific length of time for infusion at a certain rate. Other patient factors must be assessed. If this looks like a short term, one time infusion, then the risk of CVAD insertion is greater than the risk of peripheral infusion. One the other hand if the patient is unstable, has multiple infusion needs, and questionable peripiehral veins, the risk of a CVAD may be needed to manage all of the infusions. If you decide that a CVAD is not required, then these fluids require smallest peripheral catheter, NO sites in areas of joint flexion and careful attention to stabilization. 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!