Drug Extravasation Risk and Line Guideline for Nephrology Patients

Type of Med 0-5 days 6-14 days 15 days-2 month >2 months Green PIV PIV Non-tunneled CVC (Midline***) Non-tunneled CVC (PICC***) Tunneled CVC Port Yellow PIV PIV Non-tunneled CVC (Midline ***) Non tunneled CVC (PICC ***) Tunneled CVC Port Red Non-tunneled CVC (PICC***) Non-tunneled CVC (PICC***) Non-tunneled CVC (PICC ***) Tunneled CVC Port Line Selection Table – RENAL (Nephrology) CKD/ESRD patients Venous Infusion Extravasation Risk This is an estimate of risk for phlebitis or local tissue injury due to extravasation from any intravenous infusion device. Risk derived from available evidence, CCHMC data and CCHMC expert opinion, subject to review and change as further evidence becomes available. For Treatment of Extravasation, Refer to CCHMC Policy P&T II-112 This does not apply in situations of emergency medical treatment. If a medication is not on this list, please refer to the CCHMC formulary or contact pharmacy (6-4291) for information Green + Lower Risk Aminophylline Amphotericin B Liposomal Ampicillin Ampicillin/Sulbactam Cefazolin Cefotaxime Ceftazidime Ceftriaxone Cefuroxime Clindamycin D5LR Dextrose < 10% Fentanyl Fosphenytoin Furosemide Gentamicin Heparin Imipenem IVIG Lactated Ringers Lipids Magnesium sulfate (bolus) Meropenem Methylprednisolone Piperacillin/tazobactam Normal saline Ticarcilllin Pentamidine Ticarcillin/clavulanate Piperacillin Tobramycin Yellow Intermediate Risk Acetazolamide Allopurinol Amikacin Amphotericin B (conventional) 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 Red Higher Risk Acyclovir Amiodarone Caffeine Citrate Calcium (all salt forms) Dextrose > 12.5% Doxycycline Esmolol Mannitol 20% & 25% Promethazine Potassium >60 mEq/L Sodium bicarbonate > 3% Sodium chloride > 3% TPN > 950 mOsm/L Vasopressors such as Dopamine Chemotherapy Drugs Extravasation treatment: Refer to policy P&T II-113 + NOTE: No intravenous infusate is “safe”. Gross extravasation, even of normal saline, may result in serious harm including compartment syndrome, causing ischemia and loss of tissue or permanent loss of limb function. Reviewed: January 30, 2017 © 2009 – 2013 Cincinnati Children’s Hospital Medical Center v. 2016 1007 *** this situation is intended for a) the rare CKD patient where is has been discussed & documented that he/she would not be considered a candidate for future Renal Replacement Therapy (i.e. dialysis, transplant), and/or b) extremely difficult access situations. Use of a midline or PICC in a pt with documented CKD stages 2-5 OR ESRD (KTX, HD, PD pt) requires a verbal discussion with the family of risks as well as verbal discussion & approval by the nephrology attending to the VAT team nurse