Cleaning up lines

Specialties Critical

Published

Hey everyone,

So I'm a new nurse on the SICU. I just graduated in December and I am 3 weeks into orientation. It is going well-ish (everyone says I am too hard on myself), but I worry a lot about things when I go home. I'm told that's normal. :dead: Anyways, one thing that I could really use guidance on from more experienced nurses is how to clean up lines. For example, last night we had a super sick admit on our floor. This lady had an Hgb of 4.0 and had multiple pressors; we were measuring CVP, PA, bladder pressures, the works. However, when she arrived from the PACU, the lines were an absolute disaster. She had two sets of shock pads on, tons of extra lines -- just so confusing. I was focused on doing our intake assessment, but one of the other nurses managed to sort that whole mess and make it workable.

Later, I was wondering: how did she do that? I know this is probably a dumb question, but I find that often its the dumb skills-related questions that are tripping me up because I'm worried to do something that seems basic in an un-safe way. So say a person is on lots of pressors and has a whole bunch of lines that are untangled. How can you disconnect and untangle them safely? What about the transducer lines? Can I unplug CVP, PA, and A-line cables to detangle them?

What do you guys do? Any tips on how to keep lines organized when your patient has a lot of drips? We obviously use labels in our ICU, but as a new nurse I still find it hard to keep track of every line when they tangle, and I worry that I may not know all my access points in an emergency situation.

jamisaurus

154 Posts

Specializes in Critical Care.

I understand how this is overwhelming, and sometimes your lines will never look clean (due to so many) and you just make it look as nice as you can.

Start one place at a time-- with your CVC. check compatibility and combine what drips you can. Remember, whatever is secondaried in will be pushing the drug before it in so make sure your rates are similar or the slower drug is the one secondaried.

Then go to your CVP, a, line, bladder monitor. You can feed the pressure bags under the wires so you never have to untangle anything, or you can unplug QUICKLY! if you must. I always loop up cords that are really long and hang them from our monitor hooks or tape them so they're not in the way and more liable to catch. This will take time and it's good you're thinking about it. But if you go one line at a time it's not so overwhelming.

Thanks, Jamisaurus! I hadn't though about the secondary pushing the primary in and that's a great point! I do tend to find CVCs overwhelming, since there are multiple lumens and often several drugs per lumen.

When checking compatibility of drugs, do I need to check across lumens? So for example if I have a triple lumen R IJ and I am running levo and vasopressin in one, and then fentanyl and K+ in another, do I need to check the compatibility of K+ with levophed? Or do I only need to check its compatibility with the drugs running into the same lumen?

...When checking compatibility of drugs, do I need to check across lumens? So for example if I have a triple lumen R IJ and I am running levo and vasopressin in one, and then fentanyl and K+ in another, do I need to check the compatibility of K+ with levophed? Or do I only need to check its compatibility with the drugs running into the same lumen?

Only in the same lumen. Once they get to the bloodstream it does not matter.

Some may say PICC lines make a difference since all the lumens end at the same point, but it still ends in the bloodstream. I have never seen or heard of problems with it.

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Rose_Queen, BSN, MSN, RN

6 Articles; 11,658 Posts

Specializes in OR, Nursing Professional Development.

I don't work critical care (I'm cardiac OR), but I do frequently drop off and pick up patients in ICU. Unfortunately, completely untangling lines is often an impossible task. Best thing is to label lines- both on the line itself and near or even on the port it's infusing into. If a drip is discontinued/weaned off, don't leave the partially emptied bag connected- go ahead and disconnect it to get the extra line out of the way. Keep it handy if it needs to be restarted, but caps were created for a reason, and it doesn't take that terribly long to reconnect. We also use multiple IV poles when transporting patients- if it's going into a central line or the swan, it goes on one of the two poles at the head of the bed. If it's going into a peripheral IV, it's on one of the two poles at the foot of the bed.

I don't work critical care (I'm cardiac OR), but I do frequently drop off and pick up patients in ICU. Unfortunately, completely untangling lines is often an impossible task. Best thing is to label lines- both on the line itself and near or even on the port it's infusing into. If a drip is discontinued/weaned off, don't leave the partially emptied bag connected- go ahead and disconnect it to get the extra line out of the way. Keep it handy if it needs to be restarted, but caps were created for a reason, and it doesn't take that terribly long to reconnect. We also use multiple IV poles when transporting patients- if it's going into a central line or the swan, it goes on one of the two poles at the head of the bed. If it's going into a peripheral IV, it's on one of the two poles at the foot of the bed.

I hate when my patients come back from a procedure. The lines are straightened out before they go, but 95% of the time when they come back, they are a mess. I just don't get that. :no:

IV lines tangled with monitor cables all twisted up in gowns and sheets. Takes me at least 30 minutes to get it straightened out when they get back.

But I do agree, get the unused lines off there. I like using the 3 way stopcocks when I have multiple drips. Hook 3 together and you have 4 access ports, on a triple lumen, gives you quite a bit of ports (still checking for compatibility through on the same lumen). This makes it easier to disconnect lines that are not used and don't have to figure out what y's into what when changing tubing (like when your NS tubing expires that has 3 other drips going into it, having to pause them all while you change tubing).

ausrnurse

128 Posts

Specializes in ICU.

This is one of those things that just gets better with experience. First, I pull down everything that's not being used. For example, all our patients come back from theatre with noradrenaline and GTN running (why??). You're obviously only going to need one of these, so get rid of the other. They also inevitably have insulin running, diabetic or not (again, why??), get rid of this if you don't need it. Check your compatabilities. Inotropes always on their own lumen, and whatever your unit policy is for the rest. Untangle the CVP and art line, then move on to your pressure cables and monitoring. If they've been in theatre, no doubt your central line has somehow become looped six times around your ETT, so it does take a bit of time figuring it all out, and for safety reasons you need to.

I like using the 3 way stopcocks when I have multiple drips. Hook 3 together and you have 4 access ports, on a triple lumen, gives you quite a bit of ports (still checking for compatibility through on the same lumen). This makes it easier to disconnect lines that are not used and don't have to figure out what y's into what when changing tubing (like when your NS tubing expires that has 3 other drips going into it, having to pause them all while you change tubing).

Thanks for the response! Again, I'm new so I think I'm having trouble picturing what you're describing! Are you saying that you connect three 3-way stopcocks together on the same lumen?

FlyingScot, RN

2,016 Posts

Specializes in Peds/Neo CCT,Flight, ER, Hem/Onc.

It's called a manifold. There are some that are manufactured this way or you just screw together however many you need and attach to your lumen.

It's called a manifold. There are some that are manufactured this way or you just screw together however many you need and attach to your lumen.

Yup, thats it.

We don't have the pre-made ones where I work so we have to make our own.

Like I said, these greatly help with line management since you can have most everything hooked up to it's own access port. Pause 1 drip, disconnect and untangle the line and hook it back up and restart, can be done in 5-10 seconds, repeat till they are all untangled. Also with your lines labeled at the distal end, you can easily see whats running in a particular lumen without chasing lines up to the y.

Yup, thats it.

We don't have the pre-made ones where I work so we have to make our own.

Like I said, these greatly help with line management since you can have most everything hooked up to it's own access port. Pause 1 drip, disconnect and untangle the line and hook it back up and restart, can be done in 5-10 seconds, repeat till they are all untangled. Also with your lines labeled at the distal end, you can easily see whats running in a particular lumen without chasing lines up to the y.

Oh my goodness, that is frickin' amazing. I can't wait to try that.

Specializes in Pediatrics, Women’s Health.

This is one of those things that is going to get a LOT easier with time. Other have given you good advice, so I'm just going to leave you guys with this article. :)

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