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!

[Carrig RN]

I line up and connect as many 3-way stopcocks as I need for all my pressors and connect them all to the port on the CVL with a 10ml/hr carrier behind them. Everything runs into its own stopcock and the carrier brings then to the pt a little faster.

[eCCU]

We have different stop cocks, myself I prefer the one with 5 Ports....:-)

[BelgianRN]

For multiple pressors I use a train of stopcocks we have standard ones per 5 and per 3. Sometimes I'll combine 2 fives if i have many many pressors and stuff running on a single lumen.

No matter which way you use there is always mixing in the lumen leading to the patient so you'll always bolus all the others for the part that is located in the seethrough lumen. Generally to prevent this bolus from causing troubles I'll start new drips at slow rates e.g. 1 ml/min and titrate up per 1 ml every minute until i am at a desired dose this cause temporary increase in BP usually due to the increase in overall flow over the lumen but not to such an extend that it requires an intervention. I might have to say all our pressors are run in syringe pumps so we generally deal with speeds of individual pressors of 0,5 - 15 ml/hour.

[Ruby Vee, BSN]

we have "manifolds" where i work now -- essentially three stopcocks in a row. and then we'll add as many stopcocks as we need. the carrier -- d5w or ns -- goes at 20 cc/hour, and each pressor goes into it's own stopcock. there is mixing in the lumen that goes to the patient, but as long as you start new drips or titrate old ones slowly, it doesn't usually cause too many problems.

[IheartICUnursing]

Thank you all so very much for the responses! I think one of the other ICUs in our hospital uses stopcocks for this purpose so I am wondering why we don't... maybe I'll ask around some. I just like to make sure we are doing the best for our patients :)

[Biffbradford]

You're not going to see any major swings from those little 'boluses'. Vitals are always changing anyway, so have faith, blink your eyes a few times, and everything will settle down in a minute or two. I like stop cocks myself, but those manifolds are good too.

[umcRN, BSN, RN]

we use stopcocks as well but I work peds so sometimes we have very limited access. if its compatible to run together we will run it all. so on a "train" of stopcocks I might have a three way off one port with dopa/epi/milrinone then on a three way off a another stopcock I might have my 2 or 3 sedation drugs then off another stopcock i might have my maintenance fluids. etc. Like I said if its compatible we run it together in effort to have one good "push" line for anything else that needs to be given. In the unit I work in its all cardiac too so the kids are VERY limited in what good vessels they have for central access and often our best access might only be the right atrial line so we do what we gotta do.

[ICU4U]

could you post a pic of this..

[umcRN, BSN, RN]

well I don't have an actual picture from work but...

Put a few of these together (as many as you need)

Then add the "two way's" or "three ways" to each of the ports and hook up the meds you need to those

Works pretty well and like I said you can run whatever is compatible (within reason, I wouldn't put pressors here if I were going to be bolusing sedation but I could put sedation into my push line elsewhere if needed)

[medicrn13]

We have the "3 way's" at work and usually if someone is short on space we will attach those and hook an infusion up to each clave. Have seen it where people have hooked up pressors to the Y port on their IV lines, makes no sense to me, so I'll go in and change it to the 3 way connector when I take over, easier to track everything.

[thompd01]

When I run mutiple pressors, I use a 5 way stopcock device or try to have multiple lumens to infuse the medications through. I don't feel comfortable as you stated running all the pressures into one line. I feel this isn't safe for patient's and gives the nurse less control over the medications she/he is infusing. I personally prefer multiple lumens over stopcocks.

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.