[hikernurse]

Seriously. I'm embarassed to ask, since I'm not quite sure how I missed this.

Some of the meds we use are Y site compatible with TPN/lipids. How does that figure into using them? Aren't there still a few centimeters where it would mix? I had some amoxicillin precipitate once in tubing and I really don't want to have that happen again. Nothing happened to the baby; I changed the tubing and all was good.

Anyone willing to give a quick tutorial to a confused nurse?

Thanks.

[elizabells]

Aw, it's not a dumb question. My answer (and I'm sure others will have different takes) is that Y-site compatibility means it's a go. Now, if I have a kid with one of the bigger, deeper PICC lines (say a 2Fr in an ankle with a long way to go before the tip, hence more volume for mixing) and it's a big, stable kid, I might clamp off the TPN for the 15 min or so it takes to give the amox. For stuff that goes longer, you're sort of out of luck if you have only one access point. For things like Ampho that are REALLY incompatible with, like, everything, we'll run down and hook up some D5 to switch over to during the infusion so the kid is at least getting a little sugar.

My other rule (and I've found that I'm more stringent about it than others on my unit sometimes) is that a vasoactive drip should never, ever, go into a tri/quad-set that's also used for meds or fluid boluses if there is ANY other option. I don't care how little space there is to mix at the end, I've seen a kid jump off the table with a HR of 220 because someone bolused NSS through a line that had dopa and dobut running through it.

[Sweeper933]

Originally Posted by elizabells

Aw, it's not a dumb question. My answer (and I'm sure others will have different takes) is that Y-site compatibility means it's a go. Now, if I have a kid with one of the bigger, deeper PICC lines (say a 2Fr in an ankle with a long way to go before the tip, hence more volume for mixing) and it's a big, stable kid, I might clamp off the TPN for the 15 min or so it takes to give the amox. For stuff that goes longer, you're sort of out of luck if you have only one access point. For things like Ampho that are REALLY incompatible with, like, everything, we'll run down and hook up some D5 to switch over to during the infusion so the kid is at least getting a little sugar.

My other rule (and I've found that I'm more stringent about it than others on my unit sometimes) is that a vasoactive drip should never, ever, go into a tri/quad-set that's also used for meds or fluid boluses if there is ANY other option. I don't care how little space there is to mix at the end, I've seen a kid jump off the table with a HR of 220 because someone bolused NSS through a line that had dopa and dobut running through it.

That's why it's part of our protocol to have any vasoactive drips hooked up on the part of the line closer to the pumps... that way when any meds are flushed - it only flushes the little bit of the vasoactive drips that are already in the line.

[texas2007]

.....

[elizabells]

Originally Posted by Sweeper933

That's why it's part of our protocol to have any vasoactive drips hooked up on the part of the line closer to the pumps... that way when any meds are flushed - it only flushes the little bit of the vasoactive drips that are already in the line.

No, I know, and we do this too, I'm just antsy about it because of the aforementioned incident. That line had stopcocks galore on it, and the bolus was given through the lowest one, but it still happened. Obviously sometimes circumstances are such that you do what you have to do - I've given an albumin bolus through a line that had TPN, Fentanyl, and Epi (!!) running through it, but I was shaking like a leaf the entire time. There was just no other choice - the kiddo was really unstable, we had the TPN and Fentanyl going, they added the epi drip, and then came the albumin. He was so clamped down there was no WAY to get any other access, and no time. I made the attending explicitly tell me to do it, though. "So what you're saying you want me to do is..."

[Sweeper933]

Originally Posted by elizabells

I made the attending explicitly tell me to do it, though. "So what you're saying you want me to do is..."

Oh yeah... definitely have done that before... "so you really want this blood pushed in, through the UAC, as fast as we can do it???" (the baby was coding at the time... but still... that's fast for blood!)

[elizabells]

Originally Posted by Sweeper933

Oh yeah... definitely have done that before... "so you really want this blood pushed in, through the UAC, as fast as we can do it???" (the baby was coding at the time... but still... that's fast for blood!)

This was actually the same night and same incident during which I told said attending: "If you'll just be quiet a moment and let me think, I'll have that taken care of right away." This was once we did get a second line in and I was figuring out where to run all the drips and fluids.

[hikernurse]

You guys (gals ) are great . I appreciate the help--and the extra info. I knew I could count on you .

I expected a steep learning curve, but I didn't realize I'd need climbing gear to negotiate it .

[elizabells]

Oh, here's another one - if you're running lipids with a sedation drip (like Fentanyl), they may be TECHNICALLY compatible. However, experience has shown that you get better effectiveness if they are separated as much as possible.

And you WILL get it, bit by bit. I'm still kind of gobsmacked every time one of the new grads asks me a question and I just... answer it. So weird.

[Sweeper933]

Originally Posted by elizabells

And you WILL get it, bit by bit. I'm still kind of gobsmacked every time one of the new grads asks me a question and I just... answer it. So weird.

I still shake my head when one of the "vets" asks me a question... I always think to myself... you've been doing this for longer than I'm alive - yet you're asking me for advice?!?!?!

I guess that just goes to show you that the NICU is a constantly changing environment, and there's new stuff to be learned every day. There is also usually more than one correct way to do something. I guess I'm good at a lot of the "other" ways to do stuff....