Hi. I am an ICU trainee and I was taking care of a patient who had a LIJ x3 lumen who required continuous CVP monitoring (pt was retaining fluids) and was on multiple infusions (continuous & scheduled) as well. The proximal port was connected to the pt's heparin gtt, the middle one to the TPN and the distal port was connected to four 3-way-stopcocks and to CVP monitoring. The first two stopcocks were connected to an octreotide drip and a d5w infusion. My preceptor and I have checked the compatibility of our IV medications.
I understand the concept of turning the stopcocks off to the infusions to be able to obtain an accurate reading of the CVP. However, I am not quite sure what the effect of leaving the stopcocks open to the infusions and to CVP will have on my patient being able to receive the full dose of his/her infusion (i.e. will some of the meds travel down the CVP tubing instead of traveling upwards to the IJ port). We were unable to obtain PIVs on the pt because he/she was very swollen. Are there instances when it's okay to monitor CVP continuously (though not quite accurate) and infusing meds at the same time through the same port?