Irritant and Vesicants IV Administration Guidance - FormWeb

[Pages:4]Irritant and Vesicants ? IV Administration Guidance

Vesicant PIV

Midline Central comments

Drug

vs

line

Irritant

Adrenergic agent

Dobutamine

Vesicant No(F) No(A) Yes

Dopamine

Vesicant No(F) No(A) Yes

Epinephrine Norepinephrine

Vesicant No(F) No(A) Yes Vesicant No(F) No(A) Yes

Time-dependent PIV (F)

Vasopressin

Vesicant No(F) No(A) Yes

Phenylephrine

Vesicant No(F) No(A) Yes

Antiemetics

Promethazine

Vesicant Yes

No(E) Yes

For PIV: dilute & administer

slowly and in a non-hand, nonwrist vein; or give IM

Antimicrobials

Acyclovir

Irritant Yes

Yes

Yes

Amphotericin B

Irritant Yes

Yes

Yes

Ambisome (lipid based) is not

(conventional formulation)

irritant

Ampicillin

Irritant

Yes*

Yes*

Yes

*For continuous infusions,

central administration is preferred.

Doxycycline

Irritant Yes

Yes

Yes

Ganciclovir

Irritant Yes

Yes

Yes

Gentamycin

Irritant Yes

Yes

Yes

Metronidazole

Irritant Yes

Yes

Yes

Oxacillin Penicillin

Irritant Yes* No(A) Yes Irritant Yes* No(A) Yes

*For continuous infusions, central administration is preferred.

Pentamidine

Irritant Yes

Yes

Yes

Piperacillin/Tazobactam Irritant Yes

Yes

Yes

Vancomycin

Irritant Yes

Yes

Yes

Cardiovascular drugs

Acetazolamide

Irritant Yes

Yes

Yes

Amiodarone

Vesicant Yes

No(E,F) Yes

See Epic orders for details on

administration instructions. Undiluted bolus is for code situation only; concentrated drips

General recommendations for midline administration:

October 2020

A. Avoid continuous vesicants or irritants (chemotherapy, vasopressors)

B. Avoid parenteral nutrition containing >10% dextrose

C. Check midline for high pressure injector status before administering radio contrast

D. Avoid solutions with osmolality >900 mOsm/L

E. Caution with intermittent vesicant administration as extravasation more difficult to detect

F. In emergent situations, although not ideal, can be used instead of central line access

LLLLL = Central line only administration

OOOO = Midline not advised

Drug

Vesicant PIV vs Irritant

Chlorothiazide Digoxin Esmolol Milrinone Nicardipine Nitroprusside Tromethamine(THAM)

Irritant Yes Vesicant Yes Irritant Yes Irritant Yes Irritant Yes Irritant Yes Vesicant Yes

Electrolyte Mannitol 25 % bolus Mannitol 20% Dextrose 50% bolus Dextrose >10% infusion Magnesium sulfate Calcium chloride 10%

Vesicant Yes* Vesicant Yes* Vesicant Yes* Vesicant No Irritant Yes Vesicant Yes*

Calcium gluconate 10%

Vesicant Yes*

Sodium bicarb bolus (8.4%) Irritant Yes

Sodium chloride 3%

Irritant Yes

Parenteral nutrition

TPN

Vesicant No

PPN

Vesicant Yes

Procalamine

Irritant Yes

Sedatives/anesthetics

Diazepam

Vesicant Yes

Etomidate

Irritant Yes

Propofol

Irritant Yes

Midazolam infusion

Irritant Yes

Rocuronium infusion

Irritant Yes

Thiopental

Irritant Yes

Other agents

Midline Central comments line

Yes

Yes

No(E,F) Yes

No(A,F) Yes

No(A) Yes

No(A,F) Yes

Yes

Yes

No(E) Yes

should only be administered via central line. Give slowly

Use large peripheral vein; nicardipine ? change PIV every 12 hours Central line preferred In emergency: use largest vein, elevate extremity, and give slowly.

No(E,F) Yes

No(A.F) Yes

No(F) Yes

No(A) Yes

Yes

Yes

No(E) Yes

Yes

Yes

Yes

Yes

No(D) Yes

*Central line preferred; in emergency, push slowly, monitor for extravasation

* Peripheral IVP in code situation only. If giving peripherally nonemergently, dilute in 100mL NS * Peripheral IVP emergent use only. Diluted (50-100 ml) may be given peripherally. Central line preferred, do not wait for central line if emergent

No(B,D) Yes

No(A) Yes

Yes

Yes

No(E) Yes

Yes

Yes

Yes

Yes

No(A) Yes

No(A) Yes

Yes

Yes

General recommendations for midline administration:

October 2020

A. Avoid continuous vesicants or irritants (chemotherapy, vasopressors)

B. Avoid parenteral nutrition containing >10% dextrose

C. Check midline for high pressure injector status before administering radio contrast

D. Avoid solutions with osmolality >900 mOsm/L

E. Caution with intermittent vesicant administration as extravasation more difficult to detect

F. In emergent situations, although not ideal, can be used instead of central line access

LLLLL = Central line only administration

OOOO = Midline not advised

Drug

Albumin Aminophylline Epoprostenol

Vesicant PIV vs Irritant Irritant Yes Vesicant Yes Irritant Yes

Mycophenolate

Irritant Yes

Phenytoin

Vesicant Yes

Chemotherapy/Oncology

Actinomycin D

Vesicant No

Amsacrine

Vesicant No

Carmustine

Vesicant No

Cabazitaxel

Vesicant No

Dacarbazine

Vesicant No

Daunorubicin (liposomal) Vesicant No

Doxorubicin (liposomal) Vesicant No

Epirubicin

Vesicant No

Idarubicin

Vesicant No

Mitomycin C

Vesicant No

Mitoxantrone

Vesicant No

Trabectidin

Vesicant No

Vinbalastine

Vesicant No

Vindesine

Vesicant No

Vincristine

Vesicant No

Vinorelbine

Vesicant No

Arsenic Trioxide

Irritant Yes*

Bendamustine

Irritant Yes*

Bleomycin

Irritant Yes*

Carboplatin

Irritant Yes*

Cladribine

Irritant Yes*

Dexrasoxane

Irritant Yes*

Etoposide

Irritant Yes*

Pentostatin

Irritant Yes*

Teniposide

Irritant Yes*

Thiotepa

Irritant Yes*

Topotecan

Irritant Yes*

Aclacinomycin

Irritant Yes*

Midline Central comments line

Yes

Yes

No(A) Yes

Yes

Yes

Yes

Yes

No(E,F) Yes

Long-term infusion should be given centrally. If access lost, may be given peripherally or via midline short-term Peripheral: over 2 hours

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

*May be given peripherally if

No

Yes

authorized by ordering provider

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

General recommendations for midline administration:

October 2020

A. Avoid continuous vesicants or irritants (chemotherapy, vasopressors)

B. Avoid parenteral nutrition containing >10% dextrose

C. Check midline for high pressure injector status before administering radio contrast

D. Avoid solutions with osmolality >900 mOsm/L

E. Caution with intermittent vesicant administration as extravasation more difficult to detect

F. In emergent situations, although not ideal, can be used instead of central line access

LLLLL = Central line only administration

OOOO = Midline not advised

Drug

Cisplatin Docetaxel Gemtuzumab Oxaliplatin Paclitaxel

Vesicant PIV vs Irritant Irritant Yes* Irritant Yes* Irritant Yes* Irritant Yes* Irritant Yes*

Midline Central comments line

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

General recommendations for midline administration:

October 2020

A. Avoid continuous vesicants or irritants (chemotherapy, vasopressors)

B. Avoid parenteral nutrition containing >10% dextrose

C. Check midline for high pressure injector status before administering radio contrast

D. Avoid solutions with osmolality >900 mOsm/L

E. Caution with intermittent vesicant administration as extravasation more difficult to detect

F. In emergent situations, although not ideal, can be used instead of central line access

LLLLL = Central line only administration

OOOO = Midline not advised

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