Since completing my training at Cincinnati, I regularly receive a “staff bulletin.” One item that I thought was particularly worthwhile in the June 2014 was a discussion on minimizing harm related to peripheral intravenous (PIV) access and infusions.
The Cincinnati Vascular Access Team has developed a protocol to assess PIV sites (hourly nurse checks) and has developed a list of medicines, with the idea that higher risk medications should be given via a central line. The lists that follow are based on this staff bulletin and should be useful references.
High Risk Medicines include the following:
- acyclovir
- amiodarone
- caffeine citrate
- calcium (all salt forms)
- dextrose (>12.5%)
- doxycycline
- esmolol
- mannitol (20% and 25%)
- promethazine
- potassium (>60 mEq/L)
- Sodium bicarbonate
- Sodium chloride ≥3%
- TPN ≥950 mOsm/L
- Vasopressors such as dopamine
- Chemotherapy drugs
Intermediate Risk Medicines include the following:
- Acetazolamide
- Allopurinol
- Amikacin
- Amphotericin B
- Arginine
- Ciprofloxacin
- Dextrose 10 to 12.5%
- Diazepam
- Erythromycin
- Ganciclovir
- Lorazepam
- Midazolam
- Morphine
- Ondansetron
- Nafcillin
- Non-ionic Radiology contrast
- Phenobarbital
- Phenytoin
- Potassium ≤60 mEq/L
- TPN ≤950 mOsm/L
- Vancomycin
Lower Risk for the following:
- aminophylline
- amphotericin B liposomal
- ampicillin, ampicillin/sulbactam
- cefazolin
- cefotaxime
- ceftazidime
- ceftriaxone
- cefuroxime
- clindamycin
- D5LR
- dextrose <10%
- fentanyl
- forsphenytoin
- furosemide
- gentamicin
- heparin
- imipenem
- IVIG
- lactated ringer’s
- lipids
- magnesium sulfate
- meropenem
- normal saline
- pentamidine
- piperacillin, piperacillin/tazobactam
- ticarcillin, ticarcillin/clavulanate
- tobramycin
One further warning: “No intravenous infusate is ‘safe.’ Gross extravasation, even of normal saline, may result in serious harm, including compartment syndrome, ischemia, and loss of tissue or permanent loss of limb function.”
gutsandgrowth 
Comprehensive list of medications…..just wondering are these guidelines based on peer-reviewed literature or individual hospital experience?
Ben,
My understanding is that the medications/guidelines were developed solely by Cincinnati Children’s as a quality improvement project. Some of this effort dates back several years. The following web address is to an abstract regarding this topic as well: http://www.pediatricnursing.org/article/S0882-5963(12)00009-7/abstract.
Jay