Running multiple drips into one line

[IheartICUnursing]

I just wanted to ask how you all prefer to manage running multiple drips together into one line? I'm specifically thinking about pressors....For example, a patient who is on Levo, Neo, Vaso and Epi drips and they all need to go into the same lumen because the others are taken.

I know they are all compatible, but my issue is with how we usually hook them up in our unit. Most nurses will run them one behind the other; say, Levo hooked up to the line, Neo hooked up to the first port on the Levo tubing, Vaso hooked up to the first port on the Neo, etc. I just feel like this makes it difficult for the patient to quickly see any titration changes because some of them are so far down the line. Also, when you add a new one (say, I add an epi drip behind the vaso) not only will it take a while to for the patient to see it but wouldn't it be basically bolusing everything in front of it?

I'm just wondering what you guys in other units are doing... We have these little three way "pigtails" as we call them that you can hook up to the line and now have 3 individual ports to hook things up to for that one lumen. I prefer to use one of those and hook one pressor to each so that they are all the same distance from the patient and nothing is being bolused.

I've heard of people having a "drip line" "manifold" or "christmas tree" for running drips but I am not quite sure what any of those are :)

I appreciate any input!

[umcRN, BSN, RN]

If a patient is that sick, I would strongly encourage the physician to give me a CVL with multiple lumens as soon as I started to infuse multiple pressors.

which might work in an adult but the 2kg newborn with hypoplastic left heart and literally no substantial peripheral vessels doesn't get that option. We might get a double lumen UVC if lucky, otherwise its a single lumen and pivs that blow after 12 hours of use. So if it can run together it runs together.

I've had kids with a RA line, LA line, PICC and still need pivs, access can be a disaster in the little ones.

[CalvinJ]

Id go for a manifold myself. The most important part of titrating pressors in one line/lumen is just as you thought... Not running one to a bolus and with a manifold - usually a 5-way manifold, all the drips go in as equal as how you really want the drug to go in depending on your titration so one wouldn't be flushing the other just in case you titrate one up and increasing its rate. In my experience, the runner (the fluid that runs on the main lumen and meets the other ports) is the key to effective titration. I usually run it at around 40cc/hr but depends on the patient's fluid status.