Quote from RN for TIDE
As a brand new RN, all the different lines use to overwhelme me. I graduated nursing school last December and I have began my career in a Cardiac ICU. When a patient comes back from OHS after having CABG X 4 for example, sometimes there is no time to think, you need to know your stuff. Yes, I know I am being hard on myself because I just started. Next week, I begin my 5th week of orientation on the unit and it's time to start "knowing my stuff".
My question is which port do you administer blood, TPN, IVF, meds, etc... Which port is best to draw blood samples and which port does the CVP monitoring need to be connected to?
Any help would be greatly appreciated.
First and foremost, one should be checking with their employing organization to see what their P&P states is appropriate.
However, for many organizations, the Distal port (which is labeled as such) is usually used for CVP monitoring. as this is the largest lumen of the three (when it is a triple lumen IV catheter). Others, may designate this Distal port for blood draws because it yields better, being the largest lumen. Then there are some who use the proximal port of a TLC for blood drawing to prevent carrying the infusates from the other lumen(s) into the blood specimen.
Arrow, the manufacturer of the most popular percutaneously placed, non-tunnelled triple lumen IV catheter suggests:
1. Proximal: blood sampling, medications, blood administration
2. Medial: TPN
3. Distal: CVP monitoring, blood administration, high volume or viscous fluids
Also remember, that though one poster remarked that TPN needs to go into a "virgin" line, there is no study with which they can base this policy on. (not that they can't make it their policy, but it does not have scientific facts for its basis). However, once TPN is started in a lumen, then one should not infuse any other medications into that lumen, nor draw blood through that lumen. It then needs to be TPN dedicated only.
Whatever guidelines you follow, hopefully, those guidelines are followed by all at your place of emplyment. This consistancy will allow for better patient outcomes, which all of us want for our patients.
Hope this helps