Best Practices for UAC use ?!?

Specialties NICU

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Hi Everybody,

I work in a small community NICU. They routinely place double lumen UAC's for blood draws and fluid/nutrition infusion. I have been telling them that other NICU's do not routinely do this and that it is not a best practice. They disagree and have asked for research to prove this. Maybe its because it seems to be common sense but there doesn't seem to be any policies or articles out there stating what to do with and not do with a UAC. Any suggestions? What do you do in your nicu? Anyone else routinely use UAC's for TPN and such? Thanks.

Dawn

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Specializes in NICU.

You didn't mention whether or not you administer medications via UAC, but I'll toss this one out there.

http://www.medscape.com/viewarticle/460321

Also, if you read the lit review at the beginning, it references a study that showed no differences in line complications with administration of TPN in a UAC vs. CVL. I guess to me, though, if an arterial line, which always has risk of complications, is not necessary for any other reason, it would not be prudent to keep it in place for fluid infusion. There are fewer overall risks with a PIV or CVL.

We never infuse anything in the UAC except in a code/near-code without any other access. I'm interested to see what else people know!

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We never infuse anything via UAC except for Heparinized Saline.

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Specializes in ICN.

We never use double lumens on UAC. We have a double lumen UVC for TPN, meds, etc. And a single lumen UAC for blood pressure and drawing blood. In an emergency, it can be used for giving a transfusion by alloquats or giving meds, but we prefer not to do so. We only used NS with heparin or Sodium Acetate with heparin in the UAC and keep constant watch for reduced circulation in the feet and lower limbs. At the first sign of blue or white toes, the line is checked, and frequently pulled.

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Specializes in Level II & III NICU, Mother-Baby Unit.

I have never worked in a NICU that infused anything through a UAC line except generally 1/2 normal saline with 1 unit heparin/ml (sometimes sodium acetate is added too) and infuses at 0.4 to 0.5 ml/hr. Always a single lumen UAC.

TPN, lipids, medications, blood, etc. are all infused through a UVC. We always place a double lumen UVC and will place a triple lumenUVC on the smaller babies who we expect will need many different fluids which are not compatible in the same line.

I understand that certain fluids can be infused through a UAC when there is no other route but my understanding is that this is a rare and only temporary solution until another line can be placed....

Wish I knew of studies or other information to help you make your case, but I don't know of anything off the top of my head... Sorry.

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Specializes in NICU, PICU, educator.

We don't put in double lumens in the UA only the UV. We will use the UA to infuse on if it is a ELBW baby and we need the access. Remember, you can NOT put vasopressors thru a UA, only a UV. Also,not every kid gets umbilical lines...if the baby isn't intubated or a good candidate for intubation, we don't place a UA. We will place a UV on kids that have been stuck 5x for an IV upon admission.

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Specializes in Neonatal ICU (Cardiothoracic).

We never place double lumen UACs. Ours are pulled before 7 days anyway, so the use of a double lumen is limited. Our UVCs rarely stay in longer than the 48hr rule/out before a PICC is places.

UACs are pretty dangerous. We only give TPN and some meds (NEVER pressors) through UACs when other access has been tried and failed.

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