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.”
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