What is the treatment for an infiltrated intravenous (IV) line with vancomycin (Vancomycin)?

From the Guidelines

The treatment for an infiltrated IV line with vancomycin involves immediate discontinuation of the infusion and removal of the IV catheter. This is crucial to prevent further tissue damage and potential complications. The provided evidence [ 1, 1, 1 ] primarily focuses on the treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections, including guidelines for vancomycin use, but does not directly address the management of infiltrated IV lines with vancomycin. However, based on general medical knowledge and principles of managing infiltrated IV lines, especially with vesicant drugs like vancomycin, the following steps are recommended:

• Apply warm compresses to the affected area for 20-30 minutes every 2-4 hours to improve circulation and enhance absorption of the infiltrated fluid.
• Elevate the affected limb if possible to reduce swelling.
• For pain management, acetaminophen or ibuprofen may be administered.
• In cases of severe infiltration, consider applying hyaluronidase (150-200 units diluted in 1 mL normal saline) subcutaneously around the infiltration site within 1 hour of the event to help disperse the medication.
• Monitor the site for signs of tissue damage, including pain, erythema, induration, or necrosis.
• If severe tissue damage occurs, surgical consultation may be necessary.
• Document the event thoroughly, including the approximate amount of vancomycin infiltrated, and establish a new IV access site if continued vancomycin therapy is required.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Treatment for Infiltrated IV Line with Vancomycin

• The treatment for an infiltrated IV line with vancomycin involves stopping the administration of the IV fluid immediately, disconnecting the IV tube from the cannula, and aspirating any remaining drug from the cannula 2.
• Nursing intervention and thermal application are also recommended, with local cooling (ice packs) aiding in vasoconstriction and limiting the drug dispersion 2.
• The application schedule for cold applications is 15 to 20 minutes, every 4 hours, for 24 to 48 hours 2.
• In cases of vancomycin extravasation, tissue damage including blistering and necrosis have been reported, and the development of iatrogenic skin calcinosis has been observed 3.
• The ulcers can progress to re-epithelialisation following necrosis debridement and local conservative treatments 3.

Prevention of Extravasation

• Health professionals should be familiar with the extravasation management standard guidelines and regularly check the extravasation kit, assess patients’ sensory changes, and pay attention to patients’ words 2.
• Continuous education on extravasation is essential for the medical team to reduce the occurrence rate of extravasation and contribute to patient care improvement 2.

Vancomycin Pharmacokinetics and Tissue Penetration

• Vancomycin tissue concentrations have been evaluated in patients with lower-limb infections, and the results suggest that vancomycin achieves blood pharmacodynamic targets required for the likelihood of success against MRSA 4.
• The intrawound application of vancomycin powder in addition to intravenous administration of antibiotics has been reported to reduce the risk of deep infection after spinal surgeries 5.
• The tissue penetration of vancomycin into perivascular fat and arterial wall during a continuous infusion of vancomycin has been studied, and the results show that serum vancomycin concentrations are maintained within a relatively narrow range, while fat and arterial wall concentrations are highly variable 6.