Multiple drip administration - page 2

by Sugarcoma

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I recently had a pt. with multiple drips through one triple lumen central line. I am new and recently off orientation where I had multiple preceptors who each told me something different. I have searched both allnurses and... Read More


  1. 0
    Seems much simpler to just use a bag and then you never have to stop it.
  2. 0
    Quote from ShaunES
    Seems much simpler to just use a bag and then you never have to stop it.
    There are pro's and cons to any methoud I'd guess. We only have 2 volumetric pumps per bead and 6 syringe pumps so we kind of have to do it this way
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    I prefer to have vasoactive drugs and sedatives connected as close to the patient as possible, ideally with a maintenance fluid pushing 'em along. That way when I make a dose adjustment it will affect the patient as quickly as possible.
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    And we need to remember not everyone responding is from the US as there are other countires here with different laws, policies and equiptment.
    fiveofpeep likes this.
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    By "Bridge" I'm guessing you mean what is called a manifold where I work. It makes no difference what order you connect them. Same with piggybacking one fluid into another line, once the connection is made it becomes a y-splitter, it makes no difference if you connect the tip of line A into the distal port of line B or vice-versa in terms of fluid flow.
    Sugarcoma likes this.
  6. 1
    Quote from Sugarcoma
    I ended up doing the following: TPN in one lumen, Bridge on the other with 0.9@ 150 first, diprivan @ 50mcg second, Fentanyl at 50mcg third, Levo @ 50, fourth, EPI fifth and Vaso @ 0.04 last with a 0.9 chaser at KVO rate. I used my CVP port since we were measuring hourly for boluses, ABX, and pushes.
    I don't see a need for the 0.9 chaser connected to your vaso. Although it infuses at a small rate, you have your 0.9 @ 150ml/hr running behind it which will help deliver it to the patient faster.
    Sugarcoma likes this.
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    We also plug a chaser line into the last connection when we build bridges. They are multiple stopcocks connected to each other. I found a picture of something very similar here:http://img.hisupplier.com/var/userIm...Stopcock_s.jpg

    So I was able to pick my former preceptor's brain a little bit for rationale. She told me the reason she sets it up with the fastest med first is because that is usually your maintenance fluid, which is usually 0.9 and because it is positioned on the stopcock first you can use it as a push line without worrying about what is compatible with what, if you have to push something fast.
    fiveofpeep likes this.
  8. 1
    Quote from MunoRN
    By "Bridge" I'm guessing you mean what is called a manifold where I work. It makes no difference what order you connect them. Same with piggybacking one fluid into another line, once the connection is made it becomes a y-splitter, it makes no difference if you connect the tip of line A into the distal port of line B or vice-versa in terms of fluid flow.
    Wow. The first person that states what I think! It makes no difference, in general, what order you connect your drips. People are fond of stating that the fastest fluid in the back of your other connections will make them flow faster and at a more consistent rate. However, it really makes no difference. The higher flow rate fluid in the back isn't pushing anything. Think of your maintenance fluid like a river. It's flowing at a fast rate, regardless of where you add something (front or back). It gets watered down and carried along with the river regardless of where you add it.
    Sugarcoma likes this.
  9. 1
    Quote from Sugarcoma
    She told me the reason she sets it up with the fastest med first is because that is usually your maintenance fluid, which is usually 0.9 and because it is positioned on the stopcock first you can use it as a push line without worrying about what is compatible with what, if you have to push something fast.
    That sounds dangerous. If you used that first 0.9 line to push an IV medication, you're bolusing the patient with all of the vasoactive medication in the line ahead of that connection, and you will have to worry about compatibility unless you shut off all the stopcocks to your medicated drips, and flush it with saline before and after your push...but again, that's an awful idea to bolus anything through your lumen with vasoactive drips infusing.
    Sugarcoma likes this.
  10. 0
    Quote from reno1978
    that sounds dangerous. if you used that first 0.9 line to push an iv medication, you're bolusing the patient with all of the vasoactive medication in the line ahead of that connection, and you will have to worry about compatibility unless you shut off all the stopcocks to your medicated drips, and flush it with saline before and after your push...but again, that's an awful idea to bolus anything through your lumen with vasoactive drips infusing.
    i'm sorry, i mis-typed. it would actually be positioned last on the stopcock, or closest to the patient, with the drips behind it. because i am new and do not have much compatibility memorized i always try to keep an open lumen in case i have to push something fast. if i cannot do that, i will use the cvp port. i am going to continue this practice.

    wow. the first person that states what i think! it makes no difference, in general, what order you connect your drips. people are fond of stating that the fastest fluid in the back of your other connections will make them flow faster and at a more consistent rate. however, it really makes no difference. the higher flow rate fluid in the back isn't pushing anything. think of your maintenance fluid like a river. it's flowing at a fast rate, regardless of where you add something (front or back). it gets watered down and carried along with the river regardless of where you add it.

    this is what i initially was thinking myself. that because the medication is being delivered at a controlled rate via an infusion pump, position on the bridge wasn't an issue but my preceptor and coworker's felt otherwise. it really doesn't seem to matter how i set things up. it seems like the nurses who follow me always find fault with my set up. lol. i guess that is nursing.
    Last edit by Sugarcoma on Jan 9, '12 : Reason: spelling and grammar


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