Maximum number of IV meds & lines

Specialties CCU

Updated:   Published

What is the maximum number of medications ( and IV lines ) that can safely be infused to the patient and the priorities and protocols , relating to infusions. Patient will have a 3-4 port central line as a given. Patient needs TPN , Propofol, PRBC's, D5 1/2 NS , antibiotics, Dopamine , Amiodarone , Heparin, BiCarb, IV pushes , and blood will be drawn for labs thru the line. {{ Can a patient have more than one deeply placed IV access }} PS . What ports would be used ( distal vs proximal )

Cuddleswithpuddles said:

After some quick research, I learned more about how bad joining TPN with anything can be. It is not so much an issue of compatibility as it is infection control. I can see why the pharmacists OK'd my proposal to join XYZ with TPN from a compatibility perspective, but they are not the ones who are responsible for keeping the line sterile at the bedside.

What is the rationale for increased infection rates related to TPN infused with an additional compatible fluid? If the dextrose in TPN is to blame, then I would believe running a concurrent fluid through this line would only decrease the amount of dextrose. Further, if I infused an antibiotic concurrently with TPN, wouldn't that (in theory) decrease the risk of infection in this line?

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Specializes in Critical Care.
RNNCcicu98 said:
What is the rationale for increased infection rates related to TPN infused with an additional compatible fluid? If the dextrose in TPN is to blame, then I would believe running a concurrent fluid through this line would only decrease the amount of dextrose. Further, if I infused an antibiotic concurrently with TPN, wouldn't that (in theory) decrease the risk of infection in this line?

The increased infection risk is due the nutrients in TPN, specifically amino acids, dextrose actually isn't the problem. The problem is that with most IV fluids, even those that contain dextrose, if you were to introduce 10 bacteria, there would still most likely still be 10 bacteria or less present in the system the next day because bacteria can't proliferate using only dextrose (except a few gram negative bacteria that have limited proliferation in the setting of bio-film and dextrose).

Bacteria, and all living organisms, require amino acids and other nutrients to proliferate. This means if you introduce 10 bacteria to a system that contain amino acids, lipids, etc (tpn, blood products, etc), then you might have many thousands of bacteria in the system over time which greatly increases the threat to the patient.

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Specializes in CT, CCU, MICU, Trauma ICUs.

There is an app for that...Micromedex. You can download it in your smartphone. Pressing your hospital to buy a membership and making it available on the intranet is even better. My hospital has a link in the intranet for it. You can check IV compatible meds to your hearts content. You'd be surprised what is compatible; Lasix gtt and Diprivan gtt, good to go.

As for fluid volume issues, before worrying about taking away a med the pt needs, you should ask pharm to double/triple concentrate the meds. Watch your hourly I/Os. Be in contact with the physician about the I/Os.

The reason you do not run TPN with meds is the due to the vitamins/electrolytes in the solution and the high sugar content. That's how you endanger your patients with crystallized meds and having that trash run into your patient, not to mention the infection issues.

Sometimes pt's need more than one central line with multiple ports. I've had pt's with Swans in their IJs and Triple Lumens in their femoral vein. It is what it is. As far as not running blood with your meds, it's not a great idea, but you do what you have to do to. The OR certainly does not shy away from it, and that's based on the anesthesiologists call, who is more than qualified to make that decision.

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Specializes in Quality, Cardiac Stepdown, MICU.

More lines, more lines and more lines. At least 2 peripherals if possible in addition to the central lines. I've often seen pts with IJ and fem CVCs, or a triple lumen femoral or SC dialysis cath than I can infuse/draw from without needing heparin.

Hate to do peripheral lab sticks, but sometimes it's necessary.

At the 2 facilities I work at, one absolutely forbids drawing from a line that has TPN infusing in ANY lumen (not just the same lumen). The other says turn it off and flush flush flush. Check your policies always. (Not your coworkers. They work other places too and get confused too.)

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Specializes in CVICU, CCU, Heart Transplant.

TPN always needs it's own dedicated port

Bicard should be run though it's own dedicated like, as its incompatible with virtually every med.

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Thank you all for your hardearned insites , it is/ has been very usefull .

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