title: Safe administration of vancomycin through a novel midline catheter: a randomized, prospective clinical trial.
abstract: BACKGROUND
  According to the 2011 Infusion Nursing Standards of Practice, the low pH of intravenous vancomycin requires that it be administered through a central line. However, a careful review of the literature and a retrospective analysis of the experience at New York Hospital Queens (NYHQ) did not support the position of the Standards.
  
  
  OBJECTIVE
  A prospective, controlled, randomized clinical trial was conducted to determine if intravenous vancomycin could be safely administered through a novel midline catheter (POWERWAND®, Access Scientific, San Diego, CA).
  
  
  METHODS
  Patients scheduled to receive short-term (<6 days) intravenous vancomycin were randomly assigned to receive treatment through either a peripherally inserted central catheter (PICC) or the midline study device. Complications and the costs of insertion were recorded.
  
  
  RESULTS
  The two groups did not differ significantly with respect to total complications (17.9% with PICCs vs. 19.9% with the midline), phlebitis (0% vs. 0%) or thrombosis (0% vs. 0%). One suspected catheter-associated bloodstream infection did occur in the PICC group. Insertion costs were $90.00 less per insertion in the midline group.
  
  
  CONCLUSIONS
  Short-term intravenous vancomycin can be safely and cost-efficiently administered in the deep vessels of the upper arm using the midline study device.
authors.affiliation: 1 IV Team Coordinator, New York Hospital Queens, New York, NY - USA.
authors.forename: Jona V
authors.initials: JV
authors.lastname: Caparas
authors.forename: Jian-Ping
authors.initials: JP
authors.lastname: Hu
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects; D061807:Catheter Obstruction / Q000209:etiology; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000191:economics / Q000295:instrumentation*; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000191:economics / Q000295:instrumentation*; D002408:Catheters, Indwelling / Q000191:economics; D062905:Central Venous Catheters / Q000191:economics; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D004334:Drug Administration Schedule; D004867:Equipment Design; D005260:Female; D017048:Health Care Costs; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007262:Infusions, Intravenous; D008297:Male; D009519:New York City; D011446:Prospective Studies; D016459:Prosthesis-Related Infections / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome; D034941:Upper Extremity / Q000098:blood supply*; D056824:Upper Extremity Deep Vein Thrombosis / Q000209:etiology; D014640:Vancomycin / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin