Kazu

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Anyone know what medications have to go through a central line and can't go through a peripheral line. a lot times people have told me certain medications can't be given through a peripheral line when really they can, and a central is just the prefered line. Where do they have that information on medications. it doesn't seem to be in the drug monographs.
 

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Dopamine, for one (mod-high dose). d/t extravasation risk. Norepinephrine... (although you could start it on peripheral then move to central in some emergent instances). I haven't done much critical care stuff, so don't quote me on this. I'm sure some folks'll weigh in. There's a handful.
 

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Potassium will burn if given through a peripheral line.
 

njac

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a lot of medications depends on the strength of the solution - K can be given through a peripheral line but no faster than 10 mEq/hr (diluted in >50mL NS) - if the situation warrants you can give it faster through a central line.

That goes for a lot of meds - including TPN - >12.5% Dextrose must go into a central line.
 

tussionex

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a lot of medications depends on the strength of the solution - K can be given through a peripheral line but no faster than 10 mEq/hr (diluted in >50mL NS) - if the situation warrants you can give it faster through a central line.

That goes for a lot of meds - including TPN - >12.5% Dextrose must go into a central line.
TPN always goes through a central line.
lots of critical care medications are given both ways, depending on how concentrated they are. ie, we mix cardene 25mg/250ml NS for peripheral, 100mg in 50ml NS for central.
 
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Kazu

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pressors can go through a peripheral, ideally through a central but its not contraindicated to give it through a peripheral. anyone know any other common medications that must go through a central line? and where do you find that information? is that more likely ina nursing book than a pharmacy book?
 

njac

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TPN always goes through a central line.
lots of critical care medications are given both ways, depending on how concentrated they are. ie, we mix cardene 25mg/250ml NS for peripheral, 100mg in 50ml NS for central.
ok, so a PPN solution with Dextrose <12.5% can go into a peripheral line - you know what I meant.


As far as if a med can only be given in a central line that will be in the package insert.
 

njac

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Amiodarone at high concentrations. Vesicant chemo.

Another resource would be the P&T committee at the specific institution. They'll more than likely develop a list of what requires central admin...and restrictions on personnel authorized to administer, etc.
right, like certain medications limited to ICUs and telemetry units.

I'm on a couple of the ASHP e-mail listservs and it's interesting to see how many of these vary between institutions.
 

PharmDstudent

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a lot of medications depends on the strength of the solution - K can be given through a peripheral line but no faster than 10 mEq/hr (diluted in >50mL NS) - if the situation warrants you can give it faster through a central line.

That goes for a lot of meds - including TPN - >12.5% Dextrose must go into a central line.
I don't know squat about IV preps. :( I remember what they teach us in school, I can recall certain things from when I worked at a hospital, but that's all unfortunately.

So... tell me more, because I probably won't learn it otherwise until I'm a P4. :p

(I wish I could get more experience in hospital pharmacy, but I have no desire to work at a hospital as a tech/student. I don't want to have to "clean up" after nurses. They're so messy with the Pyxis machines, refrigerators, and med charts. I would rather put up reshops like magazines and candy from retail customers than be an educated healthcare worker's maid.)
 

njac

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(I wish I could get more experience in hospital pharmacy, but I have no desire to work at a hospital as a tech/student. I don't want to have to "clean up" after nurses. They're so messy with the Pyxis machines, refrigerators, and med charts. I would rather put up reshops like magazines and candy from retail customers than be an educated healthcare worker's maid.)
must depend on each hospital and their plan for interns. I don't ever feel like the nurse's "maid".

But we're also in the middle of an overhaul for interns - when I started 2 years ago it was pretty much as a tech that could legally answer questions. They're implementing a progressive intern program now. Adding more responsibilities and moving away from tech duties the longer you're there and trying to keep it in line with what we're doig in school. Obviously dispensing and distribution is the priority and if we're needed to do that, we'll help with that.
 

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I'm doing Institutional rotations and the clinical pharmacist told me that anything over 900 mOsm has to go through a Central Line. Sorry, that's all I got for ya!
 

PharmDstudent

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must depend on each hospital and their plan for interns
I think it does depend on the hospital or maybe I'm just always the lone pharmacy student. I was the only part-time pharmacy student working at that hospital. In a couple of weeks, I will be the only pharmacy intern at my retail job.
I don't mind being the only student. I just think that the pharmacists start to forget that I'm in pharmacy school, because I'm the only part-time student, which leads to more tech work.


Sorry for threadjacking --> back to the topic. I would think that a central line could get complicated. What's the deal with all of those filters and special tubing? Why do you need them???
 

tussionex

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ok, so a PPN solution with Dextrose <12.5% can go into a peripheral line - you know what I meant.


As far as if a med can only be given in a central line that will be in the package insert.

no, i wasn't correcting you...i was agreeing.
we don't make PPN's, so i wasn't even thinking of that!

sorry!:)
 

tussionex

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I think it does depend on the hospital or maybe I'm just always the lone pharmacy student. I was the only part-time pharmacy student working at that hospital. In a couple of weeks, I will be the only pharmacy intern at my retail job.
I don't mind being the only student. I just think that the pharmacists start to forget that I'm in pharmacy school, because I'm the only part-time student, which leads to more tech work.


Sorry for threadjacking --> back to the topic. I would think that a central line could get complicated. What's the deal with all of those filters and special tubing? Why do you need them???

1 - yay for a INPATIENT topic...we totally need more of these! c'mon, i know you guys have to do inpatient rotations....bring on some more questions!

2 - as far as tubing and filters go, the package insert is a good place to look. lots of drugs need special tubing and/or bags. it's early for me, but off the top of my head
- amiodarone: bag

- ampho/abelcet: filter while making, abelcet even comes with its own little filtered needle

- IVIG: filter......Hey, who pools their IVIG, and who sends up individual bottles to the floor?

- mannitol, dilantin: filter

- propofol, albumin: tubing

- LOTS of different chemo preps have myriad bag/tubing/filter needs...chemo is not my thing, can anyone else chime in?


that's all i can think of for now!
 

ShannonIV

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TPN does not always have to go through a central line. Central is best but we've had multiple peripherals.
 

njac

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we pool the IVIG into a big glass bottle and send it up - I don't filter it when I make it but I usually tape the package insert on the bottle and send it up to the floor that way. If I'm feeling nice and have the time I'll highlight infusion rates etc but it has to be kind of slow for that kind of benevolence ;)