I.V. ROUNDS: Giving vancomycin safely

December 2004 
Volume 34  Number 12
Pages 17 - 17
  PDF Version Available!


  • PICC the right catheter

  • Managing adverse reactions


    GROWING CONCERNS about antibiotic-resistant pathogens have made vancomycin the preferred drug for staphylococcal infections, especially nosocomial ones. Because of its low pH, this drug is highly irritating to blood vessels and destroys tissue if it extravasates. Consequently, you shouldn't administer it via peripheral veins—despite what you read in the package insert.

    Drugs with a pH below 5, including vancomycin, shouldn't be infused through a peripheral vein, according to current Infusion Nurses Society standards of practice. However, collaborating with the prescriber and pharmacist, you can safely infuse higher concentrations (10 to 20 mg/ml) of vancomycin through central venous catheters (CVCs).

    Although most admixtures of vancomycin are isotonic, their pH is acidic; administering them through a CVC provides adequate hemodilution. Vancomycin therapy may last several weeks, another reason for choosing a longer-lasting CVC over a peripheral device.

    PICC the right catheter

    Peripherally inserted central catheters (PICCs) are the best choice for most patients; a nontunneled percutaneous central catheter, tunneled catheter, or implanted port also may be used. Avoid midline CVCs because of the potential for local phlebitis, thrombosis, and tissue sloughing if extravasation occurs.

    Occasionally, vancomycin is prescribed until culture results are known; for example, if the prescriber suspects methicillin-resistant Staphylococcus aureus . In these cases, a CVC may not be inserted until the diagnosis is confirmed, and a peripheral catheter is the only choice. To limit the potential for vein irritation and extravasation, use a small-gauge catheter (such as 24-gauge) in the largest peripheral vein possible.

    Gravity infusions, often used in home health care or ambulatory infusion ...

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