Triple lumen central lines/test question/and flushing

  1. 0
    We had an "On the Spot" quiz at work yesterday. Something new the nurse manager has created. She brings out quizzes a couple of times a month ....and we fill in the blanks...on the spot.

    Central Line questions:
    Which lumen for infusing blood?
    " " " " tpn/lipids?
    " " " iv solutions.....d5/ns ?
    ' " " withdrawing blood for blood draws?


    And what to use for flushing the ports? how much? do you use ns or heparinized solution.....

    She was referring to a sub-clavian, triple lumen,central line i.v.

    All hospitals are not the same on this.
    Oddly enough.

    What do you do at your hospital?
  2. 12 Comments so far...

  3. 0
    The distal lumen is of course used for monitoring as for the rest there is little I have seen written but a couple of years ago there was a commercially available video on CVC lines that suggested that the distal lumen be the one for administration of blood and in the case where no monitoring was occuring it should be used for TPN. TPN should be administered through the middle lumen and never the proximal lumen. The rationale for this is that TPN is usually very damaging to tissue and if the CVC line had migrated out the middle and distal lumens were more likely to remain in the vein.

    Some hospitals use heparin locks, some n/s flushes Q6H. I don't know of anyone doing hep/saline flushes anymore since they were linked to HITS.

    Hope that helps.
  4. 0
    what is HITS?
  5. 0
    Heparin Induced Thrombocytopenia Syndrome - look it up in the MERCK manual at the bottom of the page. Thier entry is very informative.
  6. 0
    We don't have a specific policy, but in school were taught:
    Distal=Diet (tpn),IVF
    Middle=Meds
    Proximal=Phlebotomy

    We do have policies on flushing and this will probably vary for each hospital on exactly how much you're flushing with. We still use Heplock flush for these lines.
  7. 0
  8. 0
    Gwenith that is how I was taught.

    renerian
  9. 0
    I am interested in your spot quiz. Can I have a copy of the questions that you had to answer on central lines? One of our nurse educators is interested in pursing this. Many thanks.
  10. 0
    In most institutions they use the acronym "SASH" for cath maintainence.
    S - saline
    A - anitbiotic (or ordered medication)
    S - saline
    H - heparin
    This works with most all CV catheters.
    Distal port for blood
    Middle port for feeds
    proximal for drugs
    Last edit by Jailhouse RN on Apr 14, '04
  11. 0
    We used distal-mainly for TPN when called for, medial for fluids, proximal for blood. IVF can be ran through all 3 ports if needed. We also set up the distal port with pressure tubing to monitor CVP. Want to be sure to use distal for feedings so it has time to dilute out in the blood before it hits the heart.


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