On-call scenario 1: Resolution

Last updated: Tuesday, June 04, 2024

What an on-call pharmacist can advise...

IV ganciclovir 500mg should be administered as an infusion over 1 hour and 100mL of sodium chloride 0.9% is an acceptable final volume; no further dilution is required. 

Ganciclovir should be infused into a large vein with adequate blood flow. A PICC is suitable, however ganciclovir has a high pH and therefore has the potential to cause tissue damage in cases of extravasation. Close monitoring of the administration site is recommended. 

Ganciclovir is a potential teratogen and carcinogen. Therefore the nurse should wear gloves and safety glasses and avoid direct contact with the reconstituted solution. Pregnant staff should not handle the drug. Once the infusion has been administered, the empty bag and giving set should be disposed of in cytotoxic waste bins.

No. In lines that have more than one lumen such as a PICC, the lumens are separate catheters bound together. Medicines that enter via one lumen do not mix with medicines administered via one of the other lumens. The lumens exit the catheter at different points along its length and any medicines administered down them are rapidly diluted by the fast-flowing bloodstream. Therefore, if two medicines are being administered via two separate lumens, there is no need to check for compatibility issues.  

Follow up 

Ensure you document your advice in the patient’s medical notes and/or electronic drug chart, so that other nurses know how to administer further IV ganciclovir doses for this patient. It would also be helpful to let the ward pharmacist know that you were contacted out-of-hours, and what you advised.

If this scenario has made you think that you need to revisit the different types of intravenous access available, then take a look at our page on the subject here.