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Special tubing and stopcock for diprivan??????



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Jul 22, 2009 09:41 PM

Special tubing and stopcock for diprivan??????


Hi all,

Okay-I'm in a new hospital that is 'isolated and diffrerent'. Here goes...Does anyone out there use low absorption tubing for diprivan? Also, the pharmacy supplies us with a four way stopcock that "must be used" with every tubing change (which, BTW, they only do every 24hrs). There is nothing in this facilities policy on using this tubing, and even the supervisors do not know the reason for the stopcocks-the stopcocks are from B. Braun and specifically say for use with diprivan...its a STOPCOCK none the less... no different that any other stopcock in this place .As for the tubing issue...I asked one nurse why she's using this...she said it was easier to vent the tubing to prime it (again). I asked her if she thinks that gets expensive when changing the tubing every 12 hrs (that flew over her head)...she said "change the tubing every 12 hrs????" Enough said! I use the vent that comes on every tubing set but what the hell do I know...I didn't work HERE for the last 100 years-which is how old the policies are. I try to do a little spoon-feeding education without seeming like a person trashing all they've been doing, but no one seems interestede in doing things that are based on current evidence--only what they have always done. thanks for listening


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7 Comments
No. 1
from dorimar
Old Jul 22, 2009, 11:56 PM

Default Re: Special tubing and stopcock for diprivan??????
It is very difficult when you practice by "standards of practice" and evidence-based practice, and those who do not treaty you like you are the one practicing incorrectly. I worked in a rural hospital once for a year and it was a nightmare. Not because it was rural, but because the practice was not up to par and when you did it correctly, they rolled their eyes and talked down to you... Crazy.

Example: a new nurse was asking me about reading a wedge pressure and I was explaining how to measure on end-expiration. An "exprerienced nurse" butted in and snidely stated, "We don't do it that way here, we just measure the mean". When I asked her why, she stated, "because that's the way Dr. so-and-so wants it" . I just said, "ok...."
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No. 2
from pinksugar
Old Jul 26, 2009, 07:48 AM

Default Re: Special tubing and stopcock for diprivan??????
I've never heard of using a stopcock on diprivan tubing. Moving a stopcock around, especially with a substance like diprivan, *especially when the tubing is only changed every 24 hrs* just sounds like a good way for the patient to develop line sepsis.
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No. 3
from PICNICRN
Old Jul 26, 2009, 05:45 PM

Default Re: Special tubing and stopcock for diprivan??????
I wonder... do they change thier lipids Q24 also?? I think the standard is change Q12 and I cannot say that I have ever hear of the need for a stopcock kor special tubing for Propofol either.
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No. 4
from stressgal
Old Jul 27, 2009, 12:20 AM

Default Re: Special tubing and stopcock for diprivan??????
No stopcock but our policy is to change tubing q 12. We run D5 as a backup with the diprivan, diprivan placed on a seperate pump, placed at the y port. No stopcock would be needed as we can simply titrate the diprivan on it's own pump. Could that be a reason for the stopcock in your situation? Are you running the solutions concurrently?
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No. 5
from lovelylpn
Old Jul 27, 2009, 05:03 PM

Default Re: Special tubing and stopcock for diprivan??????
We do use a different tubing with our Diprivan that is meant for glass bottles and makes it easier to vent, but I've never heard of the stopcock. I'd be interested in the reasoning behind that. Also, we change tubing every 12 hours.
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No. 6
from criticalHP
Old Jul 31, 2009, 02:51 AM

Default Re: Special tubing and stopcock for diprivan??????
Originally Posted by stressgal View Post
No stopcock but our policy is to change tubing q 12. We run D5 as a backup with the diprivan, diprivan placed on a seperate pump, placed at the y port. No stopcock would be needed as we can simply titrate the diprivan on it's own pump. Could that be a reason for the stopcock in your situation? Are you running the solutions concurrently?
Frankly, Id be afraid to look at what other nurses here do with drips. I've seen things that make me burn with rage such as running IVPB abx in a line with dopamine! And then they wonder why they chase labile BP's all day and night! But just try to tell em
Personally I run all drips on it's own pump with a carrier behind it-unless it's compatible-diprivan alone. I change my tubing on lipid agents q12h-the package insert even says that on diprivan. The policy here is to change lipid tubing every 12h but I honestly don't think it clicks that diprivan is a lipid . Its just not given that often--I mean I came on shift and the damn thing was running at 85mcg/min and it had been like that for an entire 12h shift! Even the doc agrued with me when I said I wanted a concurrent drug (ativan or versed) to get the propofol down because of poss liver damage and spiking lipid profiles--this was an MI pt after all!!! I've seen propofol infusion syndrome and it is scary! As for the stopcock and the 'special' tubing...I'll claim ignorance in the policy (which doesn't exist anyway). I figure its better to get forgiveness than seek permission. And I'm the one with the CCRN--for a 50 mile radius...but most nurses here don't even know what that is so I'm the ignorant one for not knowning their 1960s ways. I can't wait to be done here: I just hope no one in my family needs care here in the stone age.
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No. 7
from criticalHP
Old Jul 31, 2009, 02:58 AM

Default Re: Special tubing and stopcock for diprivan??????
Originally Posted by lovelylpn View Post
We do use a different tubing with our Diprivan that is meant for glass bottles and makes it easier to vent, but I've never heard of the stopcock. I'd be interested in the reasoning behind that. Also, we change tubing every 12 hours.
Yes, some pump manufacturers require special tubing for glass bottles. We use alaris here so the tubing have a vent at the spike. I believe horizon NXT may use special tubing for glass but its been a while since I used that...about 8 yrs. Anyone know? And if you do use a horizon NXT does diprivan require a stopcock? My thinking is that maybe it has something to do with the pump system??? But, you would think our own pharmacy would know we use alaris, which has a vented tubing.
Like I said...this place is so isolated. It's not the end of the Earth but I can definetly see it from here
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