It seems that you could infuse meds that have Y site incompatibilities at the same time using a double lumen PICC, but I was wondering if there is a mixing that happens in the vein at the point where the meds leave the PICC--for example, doxorubicin through one lumen and an incompatible antibiotic through the other lumen. Is the superior vena cava big enough to dilute them immediately so no reactions between them happen?
It is fine to give incompatible solutions through separate lumens of a multi-lumen line. That’s one of the purposes of multiple lumens. When you think about the speed of blood flow through the veins and the relatively small amount of each medication leaving the lumens, there isn’t a potential for any kind of mixing.
Yup, you are fine to infuse two incompatible drugs! Even better? A trifusion. Oh man, I would be so pleased when I admitted a patient with one of those!
It's funny -- I was just mentioning this to a coworker the other night. I know the lumens are often staggered at the end (but not by much) and I still have some magical thinking going on that things are just going to mix together at that end point and it's no different than having a single lumen. But, the evidence bears out that it will dilute ASAP and it will be a-okay.
With any kind of double lumen cental line, each lumen is considered its own line. You need not worry about compatibility. The only reason you wouldn't run 2 things concurrently is if both were first doses of something the patient had never had before because you'd want to know which drug the patient was reacting to if he were to have a reaction.
Thanks, this is helpful. I think you are right. Do you know of any published studies? Just wondering.
The rate of blood flow at the SVC is 2000ml/min . You can see how rapid and turbulent that is and the medications are quickly integrated into the bloodstream. Most PICCs do NOT have a multi staggered tip design so all lumens while separate down the entire length of the PICC will have all medications exiting the catheter at the same point. It is the percutaneousely placed Central lines at the IJ or Subclavian that are multi-lumen that have exit points a few cms apart. You need to know the catheter design so you know the best way to draw blood and certain medications and fluids are best adminstered in the distal lumen.
This was very helpful--thank you. It has been confusing. One website (forget which one) said it is OK to infuse incompatible meds through a double lumen PICC at the same time, but then it listed two incompatible meds that were NOT OK to infuse through a double lumen PICC at the same time. It has been confusing.
Perhaps they meant in the same lumen and you misread it. Think of it this way.. You do not need to even check compatibility if you plan to administer the medication or solution in a separate lumen. You only need to check compatibility if you need or want to run something in the same lumen at the same time.
Just a thought--if it doesn't matter, why do some central lines stagger the lumen openings? But I think you are right that it doesn't matter. Just curious about the rationale for that.
The various designs and staggered tips alllow for maximum flow rates. That is why you tend to see this on acute care lines and hemodialysis lines.
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