Burning question-Maintaining Central lines

[BaseballNut]

I am curious about the proper use of triple lumen central lines for various IV solutions. I was taught in school that there is a proper order to line usage; Proximal =blood draws, medial=TPN ONLY and Distal=maintenence fluid/PCA, etc. My question is this, if the patient arrives from OR or otherwise has his lines connected in a manner other than the above, is it wrong to relocate the lines (disconnect and reconnect in the proper order)? What would be the potential complications if any? Thanks

[WalkieTalkie, RN]

The most distal (brown) is usually the most wide bore and should be used for blood draws (esp. if you are calibrating a SvO2 monitor), CVP measurements, and blood administration. I don't have a particular order to use any of the others, so I kind of just go from there. Oh, and I almost always relocate drips and what not because half the time, anesthesia doesn't check compatibilities (their idea is that if it doesn't turn white immediately, it is fine)... well, needless to say, that makes me nervous, so I run compatabilities and go from there.

Sometimes a doc will specify to leave a port open for TPN use only. That only happens on occasion.

The only problems I can think of that you would run into if you are disconnecting are 1) increased risk for infection if strict aseptic technique is not used, and 2) if the patient is on pressors, the disconnect, no matter how fast, can cause a drop in their pressure. Oh, and make sure if it is a pressor in line on one of the lumens, that you withdraw the med/blood in a 10 ml syringe prior to flushing it to avoid bolusing them with it.

Sometimes a patient will come up and have a "manifold" with a random mixture of all sorts of intraop meds running in it. I will typically leave the mainfold up at least until the patient is stable and then begin disassembling the different lines into proper (compatability checked) lumens. It really ticks off the anesthesia personnel when you take down their manifold and then the patient emergently has to go back to OR

[PICNICRN, BSN, RN]

I have always used the distal for my CVP measurement and to draw from(because it is the furthest in). If the pt comes from the OR and the lines are mixed up I usually switch them unless there are inotropes running- then I just leave them until the tubing is due to be changed and switch it at that time. (I hate it when the OR runs the drips through the distal!).

As for the other 2 ports, I've never had any set order of what goes where- although, I do try to alternate antibiotics throught the ports if possible.

Anyway... I think the potential complications would be the risk for infection by opening the lines.

[blondy2061h, MSN, RN]

We use more 5 lumen lines than 3 lumen lines. We use one line just for anti-rejection meds, and I've never heard of setting up other lines specifically. I'm probably doing it wrong.

[pricklypear]

I was never aware of any proper usage of any specific lumen except using the distal (brown) lumen for CVP monitoring. It seems that every institution has it's own policy or opinion, though.

I don't think I've ever seen a 5 lumen line.

[BaseballNut]

THank you all for your time and responses