Is the pH of vancomycin an indication for central venous access?

All vascular access devices (VADs) have associated risks and benefits. Therefore, the decision to place a particular VAD rests on the assumption that the benefits of that device will outweigh the risks and allow for effective delivery of the treatment plan. The study by Caparas and colleagues, in the present issue of JVA, challenges the pH restrictions presented in the Standards. Caparas and her team have reconfirmed the previously reported findings that peripheral venous administration of vancomycin carries a low risk of phlebitis and extravasation and an even lower risk of catheter-related bloodstream infection. Central venous administration of vancomycin, on the other hand, carries the greater risk of central line associated bloodstream infection and deep vein thrombosis (DVT). In light of these findings and a lack of evidence to the contrary, the decision to place a central venous access device based solely on the pH of the intended therapy, vancomycin in particular, is not supported by the evidence and findings of this study. From a risk-benefit perspective, based on Caparas's study evidence, midline catheters are a safe option for patients for the administration of vancomycin, under specific concentrations, and for many other indicated medications and solutions.