I had a discrepancy the other day between my preceptor and a midwife about it fluid rates. My patient had one iv site with LR running at 125 cc/h and pitocin at 8miliunits. The patients glucose dropped so the midwife orderedto d/c the 125 LR and run d5LR at 50 cc/h and LR at 75cc/h along with the pitocin. My preceptor had told me that the only way I could do that would be if I started another line because they would be at two separate rates whereas the midwife said to set three separate pumps into one line. They ended up just agreeing to set the d5 LR at 125 but my question still is would we have to set a new line or could you run three pumps at a different rate into one line?
The mideife was correct, although I don't understand whe he or she didn't just order the D5LR at 125 mL/hr to begin with. If you mean IV site when you say line, did your preceptor explain the rationale for this, or did he or she just say it had to be done?
Technically you can run them all through the one line but the way you explained it in your post there was LR running at 75/hr and D5LR running at 50/hr. If they wanted the D5LR to run at 125/hr then the D5 is running too slow (@ 50/hr). Maybe I am misunderstanding?
But if the D5 is ok to run at 50/hr, then you can just use the 3 pumps and y-site two of the lines below the level of the pump.
I don't know why your preceptor believes another "line" would have to be started to run two different fluids at different rates, if by line you mean another IV. You could of course run both D5LR and LR together in the same IV by running them on their own pumps and then y-siting them together below the pumps.
If the patient is truly hypoglycemic then it probably isn't going to hurt to run D5LR at the total volume rate of 125ml/hr at least until their BG returns to normal. The advantage to running them separately is that after the BG returns to normal you could adjust the ratio of D5LR to plain LR to maintain a stable BG (assuming D5LR at 125 causes it rise). Running the two at 50ml/hr for the D5LR and 75ml/hr for the LR for instance would essentially be infusing D2LR at 125ml/hr.
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