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Intermittently Delivered IV Medication and pH

Reevaluating the Evidence

Gorski, Lisa A. MS, RN, CRNI®, HHCNS-BC, FAAN; Hagle, Mary E. PhD, RN, FAAN; Bierman, Steve MD

doi: 10.1097/NAN.0000000000000081

The Infusion Nurses Society's Infusion Nursing Standards of Practice has treated pH as a critical factor in the decision-making process for vascular access device selection, stating that an infusate with a pH less than 5 or greater than 9 is not appropriate for short peripheral or midline catheters. Because of the Standards, drug pH is not an uncommon factor driving the decision for central vascular access. In this era of commitment to evidence-based practice, the pH recommendation requires reevaluation and a critical review of the research leading to infusate pH as a decisional factor. In this narrative literature review, historical and current research was appraised and synthesized for pH of intermittently delivered intravenous medications and the development of infusion thrombophlebitis. On the basis of this review, the authors conclude and assert that pH alone is not an evidence-based indication for central line placement.

Wheaton Franciscan Home Health & Hospice, Milwaukee, Wisconsin (Ms Gorski); Clement J. Zablocki VA Medical Center, Milwaukee, Wisconsin (Dr Hagle); University of Wisconsin-Milwaukee, Milwaukee, Wisconsin (Dr Hagle); and Access Scientific LLC, San Diego, California (Dr Bierman).

Lisa A. Gorski, MS, RN, CRNI®, HHCNS-BC, FAAN, has been a clinical nurse specialist at Wheaton Franciscan Home Health and Hospice in Milwaukee, Wisconsin, since 1985. She served as INS' president from 2007 to 2008 and is the chairperson of INS Standards of Practice Committee.

Mary E. Hagle, PhD, RN, FAAN, worked as a clinical nurse specialist in oncology for many years, then as a clinical researcher for the past 14 years. Currently, she is a nurse scientist with Clement J. Zablocki Veterans Affairs Medical Center in Milwaukee and an adjunct clinical assistant professor at the University of Wisconsin-Milwaukee. She is president of the Southeast Wisconsin Chapter of INS and a member of INS' Standards of Practice Committee.

Steve Bierman, MD, who is board certified in emergency medicine, family practice, and medical hypnosis, was an emergency physician for 18 years before founding Venetec International in 2001. He is currently founder and chief medical officer of Access Scientific, LLC, in San Diego, California.

Corresponding Author: Lisa A. Gorski, MS, RN, CRNI®, HHCNS-BC, FAAN, 12403 N. Hawks Glen Ct., Mequon, WI 53097 (

Disclosure: The content is the responsibility of the authors alone and does not necessarily reflect the views or policies of the Department of Veterans Affairs or the United States government, nor does mention of trade names, commercial products, or organizations imply endorsement by the US government.

© Copyright 2015 by Infusion Nurses Society