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 google for an answer to my question but have not really found anything.
In my situation the pt was on levo, vaso, fentanyl, diprivan, epi, 0.9 maintenance as well as receiving boluses of 0.9 and albumin, and multiple ABX piggybacks. We were also treating according to CVP so I needed to keep that port open. The pt. also had TPN so that took up another port. I had one lumen to run all the other meds through so I made a bridge, grouped my vaso actives together and then plugged them into the bridge according to rate. I was taught by my main preceptor to place the most turbulent or highest flow rate, closest to the pt. which I did. Several coworkers argued with me and stated you should place the slowest drip rate closest since the higher rate meds would "push" the slower rate meds in. I have only found one article online regarding this issue and it basically said that placement of medication on a multi infusion set can affect the rate of delivery to pt. It listed a formula where you need to know the dead space and resovoir of your IV tubing etc, but it didn't give any real answers just concluded this was an area where further study was warranted.
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.
How do you guys place your meds? And do you have any resources with rationale? I have looked in my AACN book, my critical care references, and unit policies with no success. My rationale for following my preceptors methods was that she had the most years of experience.