Y-site versus Piggyback - Page 2Register Today!
- Oct 13, '12 by 8mpgI will stereotypically run multiple pumps and "Y" site medications on the port just above the distal end that connects to the IV catheter. This allows for minimal mixing and for the least amount of time before picked up by the body.
As said above, you must watch out about tubing. When connecting a piggyback on the pump and running the two on the same line, dont forget increasing the speed will push the current medication into the patient faster. Our pump tubing (primary) is 14cc with 7cc secondary tubing that would piggyback onto the main medication. When using cardiac drugs or drugs such as insulin, you can quickly overdose your patient. This happens to everyone once and you will learn quickly. I believe that using the hub above the distal end is much safer due to having 1cc of a concentrated primary drug pushed in faster than you want. Having an epi drip push in 14cc because you added a levophed piggyback will skyrocket pressures.
I personally wouldnt worry to much about medications such as zosyn and lasix personally but would run them on spearate pumps if possible. Dont forget, when giving a small amount of medication (say 50cc of flagyl) 14cc will stay in the tubing thus resulting in a 28% less medication than they were supposed to get.
- Oct 13, '12 by iluvivtAbsolutely, you can administer incompatible medications through multi-lumen PICCs and CVCs.There is absolutely NO need to stagger them unless you are doing that for a specific clinical reason. Many designs made by Edwards and Arrow have multi-tip staggered designs so the distal.medial and proximal lumens will exit a few cms apart but even if they do not, such as in many PICC designs it is still acceptable. Th average SVC diameter is about 1.5 cm to 1.6 cm the IVF is slightly larger. The blood flow into the SVC is 2 liters per minute so you can see there is rapid hemodilution and mixing. Go into any ICU and you will see all the drips going at once through triple lumen CVCs as that is their main purpose to administer multiple IV medications and IV therapies at the same time.
The trend in IV therapy is venous preservation and not destroy the peripheral vasculature. This has many components but one being do not start unnecessary PIVs so if you do not need a second PIV do not start one. Yes a lot of times you do and you have to do it. Then the question arises what is the most appropriate access for the patient at this time? Early assessment of the patients vein,diagnosis and treatment plan needs to be evaluated.