Concurrent IVS

wooh, BSN, RN · Jun 25, 2014

If you add it using a minbore double ext set triple extension set or a T-extension it is NOT considered mixing so you would not even have to wory about compatability. You will preserve the vein(s) you do not use for future use or no use at all depending upon several factors such as the duration of therapy.

Please clarify this. So if I have one IV, with a Y (or triple or whatever) going into it, I don't have to worry about compatibility? Is this only if the Y is directly screwed into cannula, or can I have (what we usually end up with) a cannula to extension to Y to whatever is hooked to it?

Even if the Y has to go directly to cannula, this is mind blowing if I'm understanding you correctly. I always thought it had to go separate cannulas (or at least separate lumens on a CVL.)

Twinmom06, ASN, APN · Jun 25, 2014

we frequently run Protonix and NSS together - separate pumps with the Protonix Y sited into the lowest port (nearest to the IV hub). We use B Braun pumps and have to run separate pumps and separate primary lines but since they are compatible we run them concurrently.

iluvivt, BSN, RN · Jun 26, 2014

Thank you IVRUS. I do know that nurses do not realize that each manufacturer has peripheral catheters have a ml per min max rate. I Just want to scream then educate,of course, that a 22 gauge is not a horrible awful little IV. I often get calls to replace a perfectly good IVs just because their is this belief that big is better or that because it a 22 or 24 will it will have problems sooner. I am not talking about a patient with a legitimate reason such as one going to surgery,having a CT scan or needing blood products (Yes you can use a 22 for blood but I still prefer a 20 as I find they leak less). I love the calls where the nurse or nurses poke 5 or 6 times then call for help and have the nerve to criticize my 22 gauge! Sadly, there are those nurses. I will bring my flow rate chart with me now and just point that out from now on...I think that will be very effective. Recently my partner and I worked on this 5 mo old baby boy that came inot the ED with multiple birth defects. My partner actually got it with the the use of the Preview US but alas it infiltrated immediately because it a 1 inch catheter and with the nature of the angle used it we lost the line.

We were crammed into a very small room with 2 parents,a lot of noise and chaos around us and the grandparents kept opening the curtain. saying, "did you get it yet". After my second attempt and looking and applying warm packs I got a beautiful 24 gauge in and also got all the blood they wanted. We secured the site, labeled all the blood and started to exit to locate the primary nurse who started to question us of all things about the gauge we got in. He was critical that we used a 24....did I ever set him straight :devil: . That still makes me angry when I think about it but I also laugh because after we left my partner said ##### I was going to kill you if you did not get that in...this is a very kind IV nurse . I had every intention of getting it and getting what that patient needed you bet I was !!!

annie.rn · Jun 27, 2014

I am the queen if the 22G IV if the patient is stable and won't be requiring any tests. I once attended a national nursing conference and listened to an expert on IV therapy tell us that the smaller the gauge IV, the less trauma there is to the vein b/c there is more room for blood flow around the catheter. This made so much sense to me and I've never forgotten it. Nurses will make snotty comments if I only put in a 22G. A recent quote during report after I switched out a red and swollen 18G IV w/ a 22G on a patient who was a very difficult stick: "Hmmpfh! That 22 isn't going to last long with that Morphine PCA!" I just ignored it and moved on. Most people, I will tell them about the decreased chance if phlebitis, etc.

I think it seems to be an ego thing. The bigger the IV you get in, the better the IV starter you are. That may be true but it's silly to subject someone w/ poor veins to an 18 or 20 gauge IV just to prove oneself.

I'm going to find a flow rate chart and print it off.

Thank you for educating us on the flow rate information!

~PedsRN~, BSN, RN · Jul 2, 2014

Sorry if I am hijacking your question to the quoted poster but since I answered pretty much the same thing, I think I can clarify. We use the Abbott Plum X pump (picture here: http://www.isismedical.net/Infusi1.jpg) and it can run two things concurrently, one being on the "A" (primary) line and one being on the "B" (typically "piggyback") line. You program the "A" side and press START. Then you attach the second IV using secondary tubing to the port on the cartridge (after flushing the line) and run it on the "B" line. The pump allows the user to select "Concurrent" instead of "Piggyback" as the MODE and when you press START, both will run at the same time instead of B running as a piggyback.
We use it mainly for TPN with lipids. We run the TPN on the primary tubing with the lipids on the secondary tubing running in "CONCURRENT" mode instead of "PIGGYBACK" mode so you only need one pump and only one IV port to plug the line into. We also use CONCURRENT a lot when a patient is on Ocreotide or a continuous antibiotic gtt and they also have IVF. The IVF run on the "A" line and the Ocreotide or ABX run on the "B" line in Concurrent mode. I love it. I've never used pumps that can do this until working at the hospital I work at now.
There is no need for the primary bag to be higher than the secondary bag. In fact, we always throw away the hanger that comes in the bag with the secondary tubing.
As I said in my original response, I have never seen an order like the original poster is asking about. I have never had to program a concurrent IV for more than 50cc/hr so I am not sure if there is an upper limit on the rate if the Concurrent IV. If I were to try to program it as a Concurrent and the rate was too high, I'd grab a second pump and Y-site it or use a pigtail.

What she said. :)