Can intravenous (IV) vancomycin be administered through a peripheral intravenous line?

From the Guidelines

Yes, intravenous (IV) vancomycin can be administered through a peripheral line, but certain precautions must be taken to minimize the risk of phlebitis and tissue damage. The concentration should not exceed 5 mg/mL when given peripherally, as indicated in the study 1. The infusion rate should be slow, typically over at least 60 minutes for doses up to 1 gram, and 90-120 minutes for larger doses. Proper dilution in an appropriate volume of compatible fluid (usually normal saline or D5W) is essential. Nurses should monitor the IV site frequently for signs of inflammation, pain, or extravasation. If peripheral administration is planned for more than a few days or if the patient has poor venous access, a central line may be preferable, as suggested by the guidelines 1. This caution is necessary because vancomycin is considered a vesicant medication that can cause tissue damage if it leaks outside the vein. For patients requiring long-term vancomycin therapy or those with limited peripheral access, central venous access provides a safer alternative. Some key points to consider when administering vancomycin through a peripheral line include:

• Monitoring the patient closely for signs of phlebitis or tissue damage
• Using a compatible fluid for dilution, such as normal saline or D5W
• Administering the medication slowly over a period of at least 60 minutes for doses up to 1 gram
• Considering alternative routes of administration, such as central venous access, for patients with poor venous access or those requiring long-term therapy. According to the most recent study 1, the evidence assessing harm from administering vancomycin via a peripheral catheter is of very low quality, but it is still recommended to take precautions to minimize the risk of complications.

From the FDA Drug Label

Vancomycin hydrochloride for injection is irritating to tissue and must be given by a secure IV route of administration. Thrombophlebitis may occur, the frequency and severity of which can be minimized by administering the drug slowly as a dilute solution (2. 5 to 5 g/L) and by rotation of venous access sites.

IV Vancomycin Administration:

• IV vancomycin can be administered through a peripheral line, but it is recommended to administer the drug slowly as a dilute solution and rotate venous access sites to minimize the risk of thrombophlebitis.
• It is essential to ensure a secure IV route of administration, as vancomycin is irritating to tissue and can cause pain, tenderness, and necrosis with intramuscular injection or inadvertent extravasation 2.

From the Research

Administration of IV Vancomycin through Peripheral Lines

• The administration of vancomycin through peripheral lines is a common practice, despite guidelines recommending central venous access for prolonged administration 3, 4.
• Studies have shown that peripheral infusion of vancomycin is associated with a risk of venous thrombosis, phlebitis, and endothelial toxicity, particularly when administered in high concentrations or for extended periods 3, 4.
• However, some studies suggest that the risk of phlebitis and thrombosis can be mitigated by using midline catheters, diluting the vancomycin solution, and implementing phlebitis prevention guidelines 5, 6, 7.

Risks and Considerations

• The risk of venous thrombosis and phlebitis is higher when vancomycin is administered through peripheral lines, particularly in the absence of proper dilution and infusion protocols 3, 4.
• The combination of vancomycin with other antibiotics can increase the risk of endothelial toxicity and phlebitis, highlighting the need for careful consideration of infusion protocols and drug interactions 4.
• The use of midline catheters and phlebitis prevention guidelines can help reduce the risk of complications associated with peripheral vancomycin infusion 5, 6, 7.

Clinical Implications

• Clinicians should carefully weigh the benefits and risks of administering vancomycin through peripheral lines, considering factors such as the duration of therapy, patient population, and availability of central venous access 3, 4, 5.
• The development of evidence-based guidelines and protocols for the administration of vancomycin through peripheral lines can help minimize the risk of complications and improve patient outcomes 5, 6, 7.