Questions about Triple Lumen Central Catheters

  1. 0 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.
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  3. Visit  RN for TIDE} profile page

    About RN for TIDE

    33 Years Old; Joined Feb '10; Posts: 5; Likes: 1.

    11 Comments so far...

  4. Visit  netglow} profile page
    0
    how about this?

    http://www.icufaqs.org/
  5. Visit  Ivanna_Nurse} profile page
    0
    CVP's and blood draws are usually done from the distal port, which is the brown one. For the best guide to practice, check your ICU's policy and procedures. Good Luck, it will get a little easier every day... Ivanna
  6. Visit  JulieCVICURN} profile page
    0
    The only thing that's a given is that you do CVP's in the distal (brown) port. Other than that, we use any port for any med/fluid admin, or for blood draws. We try to avoid doing blood draws off of any port that has a serious med (like a pressor) or TPN going because it's difficult to flush it well enough to avoid the TPN affecting your labs.

    ETA: I love icufaqs.com! I read the central line stuff, and my facility does not have any sort of policy that once you take TPN off of a port you can't use it for TPN again. Is this common?
  7. Visit  netglow} profile page
    0
    Julie, heck if I know, LOL. I did my management rotation in ICU, and used this for some study. Hopefully somebody else will have a good source to post for her.
  8. Visit  sunnycalifRN} profile page
    0
    it can be overwhelming, at first.

    the standard use of the ports is:

    brown (distal) for CVP monitoring, but can also be used for piggybacks, IV pushes, blood transfusion. Do not put a drip on this port, though, because it mainly is used to monitor the CVP.

    white and blue: usually one is for drip infusion, a manifold is usually used and the IV fluid is hooked up to push in the drip (as long as it's not bicarb . . . bicarb must always run alone, preferably on a separate peripheral IV). The other port can be for TPN/lipid but realize that the port must be "virgin", never used before. If TPN/lipid not in use, the other port can be for occasional IV pushes, blood transfusion, piggybacks, whatever.

    Remember, you can never do an IV push on the drip line (with the manifold) because you will bolus the various drip meds that are running. Always do your IV pushes on either the CVP line or the "other" port.

    Drawing blood samples. Always is best to use your art line because then you don't have to pause and flush lines. If you have no art line, then, first choice would be to use a large bore peripheral IV that draws well, because you don't have to mess with pausing/flushing.

    If this is not an option, and you must use your central line to draw, then you must pause your drips (if you can) . . . sometimes, pts are so pressor dependent, that you just can't pause the pressor, even for the 20 seconds you'll need. But, ideal situation is to pause all drips on the drip line, flush the CVP line with at least 10 ml of NS, then draw your waste, followed by your sample . . . flush the CVP, and restart those drips. You can see why it's much better to use your art line . . . much less chance of inaccurate results due to "dribbling" from the drip line port.

    Good luck with your continuing orientation
  9. Visit  jlcole45} profile page
    0
    Usually the distal port for blood draws, any port can be used to administer blood and other things such as meds.
  10. Visit  tri-rn} profile page
    1
    [quote=sunnycalifRN;4136611]it can be overwhelming, at first.

    "...(as long as it's not bicarb . . . bicarb must always run alone..."

    Why does bicarb have to run alone? Just this week pharmacy told me to Y site in a KCl piggyback.
    netglow likes this.
  11. Visit  lifetimern} profile page
    1
    [quote=tri-rn;4136691]
    Quote from sunnycalifRN
    it can be overwhelming, at first.

    "...(as long as it's not bicarb . . . bicarb must always run alone..."

    Why does bicarb have to run alone? Just this week pharmacy told me to Y site in a KCl piggyback.
    Like most things, this is not an absolute rule; however, bicarb. is incompatible with so many other substances that it is usually wise to run it alone. BTW, sometimes the incompatibility can be more subtle than actual precipitation (just because you can't see a change in the character of the solution, doesn't mean something isn't happening). NaHCO3 can bond to the IV tubing and substantially affect the Ph of other solutions which can alter the effectiveness and, in some cases, the chemical compositions of those substances.
    netglow likes this.
  12. Visit  sunnycalifRN} profile page
    0
    [quote=tri-rn;4136691]
    Quote from sunnycalifRN
    it can be overwhelming, at first.

    "...(as long as it's not bicarb . . . bicarb must always run alone..."

    Why does bicarb have to run alone? Just this week pharmacy told me to Y site in a KCl piggyback.
    bicarb, to be safe, should always run alone, because it can precipitate with so many substances. I always check the IV compability using Micromedex, if I must run something with the bicarb.
  13. Visit  RN for TIDE} profile page
    0
    Thanks so much for everyones help. I really appreciate it. www.icufaqs.com is a fabulous website by the way.
  14. Visit  IVRUS} profile page
    0
    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.
    Well,
    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


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