What should be done if vancomycin (Vancomycin) IV infiltrates?

Management of Vancomycin IV Infiltration

If vancomycin infiltrates during IV administration, immediately stop the infusion, elevate the affected limb, and apply warm compresses to the area to promote absorption and minimize tissue damage.

Immediate Actions

When vancomycin infiltrates into surrounding tissue during IV administration, prompt action is necessary to minimize tissue damage and potential complications:

1. Stop the infusion immediately - This is the critical first step to prevent further extravasation of vancomycin into surrounding tissues.

2. Remove the IV catheter - The infiltrated IV line should be removed to prevent additional medication from entering the tissue.

3. Elevate the affected limb - Position the affected extremity above the level of the heart to reduce swelling and promote absorption.

4. Apply warm compresses - Apply warm, moist compresses to the affected area for 20-30 minutes every 6-8 hours to:

   • Increase blood flow to the area
   • Enhance absorption of the infiltrated medication
   • Reduce inflammation and pain

Monitoring and Follow-up

After initial management, close monitoring is essential:

• Document the event - Record the approximate amount of vancomycin infiltrated, site appearance, and interventions performed.

• Monitor for signs of tissue damage - Assess the site for:

  • Erythema (redness)
  • Swelling
  • Pain or tenderness
  • Induration (hardening)
  • Blistering
  • Necrosis

• Regular reassessment - Continue to monitor the site every 1-2 hours for the first 24 hours, then daily until resolved.

Special Considerations

• Vancomycin properties - Vancomycin has a pH of 2.5-4.5, making it potentially irritating to tissues when infiltrated 1.

• Severe infiltrations - For large volume infiltrations or signs of severe tissue damage, consider consultation with:

  • Plastic surgery
  • Wound care specialist
  • Dermatology

• Restart therapy - When restarting vancomycin therapy, select a new IV site, preferably in a different extremity.

• Proper administration technique - To prevent future infiltrations:

  • Ensure proper IV catheter placement before starting infusion
  • Use appropriate infusion rates (typically not exceeding 10 mg/min) 2
  • Each dose should be administered over at least 60 minutes 2
  • For doses >1g, extend infusion period to 1.5-2 hours 2

Pitfalls and Caveats

• Avoid cold compresses - Unlike some other extravasations, warm (not cold) compresses are recommended for vancomycin infiltration to enhance absorption.

• Do not inject antidotes - There is no specific antidote for vancomycin extravasation that should be injected into the site.

• Avoid massage - Direct massage of the affected area may spread the medication further into tissues and increase damage.

• Document allergic reactions - Distinguish between infiltration reactions and true allergic reactions to vancomycin (e.g., Red Man Syndrome), which would require different management.

• Monitoring for nephrotoxicity - After significant infiltrations, continue to monitor renal function as vancomycin may still be absorbed systemically 2.