I have been asked by my fellow staff if any NICUs that use dual UVC catheters - clamp off one line if not needed. I have not been able to find any literature that will support this as a safe practice. We have several premies that are on restricted fluid intake and have poor peripheral IV access. Our Neo docs want to clamp off one of the dual lines so they do not have to use 2 TPN IV bags. If any NICU does clamp off one line do you have a policy for this and would you provide the literature that will support it. Thanks
Jul 1, '09
If we have a dual-lumen UVC line, we use the larger lumen for maintenance fluids; if not needed, the 2nd lumen is KVO with a solution such as 1/4NS with 1:1 heparin at 0.5-1ml/hr. I would hate to clamp off an unsued port and have it clot off, only to find that we may need to use it in a few days if the infant's condition deteriorates.
Jul 2, '09
One place I worked clamped the line and simply flushed with 0.5cc 1u/ml heparin every few hours. Not the most aseptic practice, but it kept the lines from clotting.
Where I am now, we don't use double lumen UVCs or PICCs.
Jul 2, '09
When we have double-lumen UVCs, we attach a 10mL syringe with our NSS/Heparin flush solution to a medline, attach that to the second lumen, and flush with that solution every six hours. We use that lumen for any medications that we haveto infuse. We do the same with double-lumen PICCs.
Regarding aseptic technique...these lines are changed out every 72 hours using sterile technique, just as our TPN is. We keep a med port hub at the top of that second lumen so we can scrub it with chloraprep before attaching the new tubing to it.
Jul 2, '09
I'm with yappymutts.We run D10 w/heparin at a KVO through our second line. I'd be afraid of it clotting if it was clamped.
Jul 3, '09
We never clamp off the the secondary port, doesn't that defeat the purpose of using a double lumen catheter? Depending on the neo that is there we either use two bags of TPN, run fluid like 1/4NS at 0.5/hr, or take TPN from the bag from the port after the filter with a syringe and run it on a med pump (we split the tpn rate between the two).
Jul 4, '09
We have tubing that starts out with a single spike but separates into two catheters for dual lumen UVC's, so we only need one bag. We can go as low as 1ml/hr on each side, so there is no need to stop using one lumen. That might keep your neos happy!
Jul 5, '09
Wow, I've never heard of using 2 bags of TPN...do they get a dual charge for that?
We use dual lumens on PICCS and UVCs....we either run a KVO or lipids thru the other port if we aren't using it for meds. If we have meds, it is on a separate med line with a flush attached to it (closed system).
Jul 6, '09
We flush our unused ports with 0.5 or 1 ml (10 u/ml) of heparin q12, depending on the size of the kid.
Jul 7, '09
We run TPN through both lines. Our pharmacy sends us two syringes and we simply split our TFL between the 2 lines. TFL = 1ml/hr, we run 0.5 and 0.5
Jul 7, '09
We put a PRN adaptor on the end of our 2nd UVC lumen. We use it for meds - and just flush with NS afterwards, and with heparin q8. Don't recall there ever being a problem with that 2nd lumen clotting off.
Must Read Topics