Vasoactive meds/ Inotropes + Rate

[RoyalNurse]

Okay,

When you hook up a NTG drip to a peripheral IV that's ordered to be 10 mcg/min, then attach NS at 75 cc/hour to it, aren't you affecting the rate of the NTG drip? That's what I had always thought, but I can't tell you how many times I find my patient with Integrillin, NTG and NS at 75 cc/hr all on one peripheral IV.

Last week I found my patient with Dopamine at 2 mcg/kg/min, with NS at 80 cc/hour attached to a central line.

Maybe we need an inservice? Or do I need the inservice?

Thanks in advance for any replies!

[Virgo_RN, BSN, RN]

If each med is on its own pump, and each pump is programmed correctly, then no, you aren't affecting the rate of the individual drugs.

[RoyalNurse]

then why do we hook up a carrier to levo, if the levo rate is less than 10?

I was taught, and I've seen for myself, that adding ns carriers to drips makes them faster.

[MatthewRN]

Most anything except heparin that's going less than 10 ml/hr you would add a carrier to as something going less than 10 is inadequate to keep the line patent.

[Virgo_RN, BSN, RN]

then why do we hook up a carrier to levo, if the levo rate is less than 10?

I was taught, and I've seen for myself, that adding ns carriers to drips makes them faster.

Because the line could clot off with the low volume going through it. The carrier simply adds more volume, it does not increase the rate of the drug. Rate is how quickly the drug is going through the catheter. Volume is how much is going through the catheter. If Y-siting some NS with the drug is causing the drug to drip faster, you've got a faulty pump.

[perkizme]

Agree with above- that's what so-called "smart pumps" are for. To help prevent human error associated with drip rates, doses, etc. As long as your pump is programmed correctly, its only going to deliver the dose of drug you put in, regardless of what else is flowin above or below it in the line.

[joeyzstj, LPN]

Think of the drugs joining at the Y in the tubing as a fast moving river with someone standing on the side with a garden hose driping into the river at a specific rate. No matter how fast the river moves, the rate that you are driping the garden hose in doesnt have anything to do with the river at all. The rate that the garden hose drips doesnt change. Most central lines/PICC lines require 20-30 ml's an hour to keep the port open properly. As someone mentioned above, the carries has absolutely no effect on the amount of the drug being given......NONE. It is simple to help keep the port open and deliver volume.

[WalkieTalkie, RN]

Plug the nitro into one of the ports on the NS tubing and then plug the tubing in the IV/line. When I first started I couldn't figure out why my patient's HR suddenly skyrocketed until I realized I was giving a fluid bolus into the dopamine line (NS was plugged into the dopamine tubing)

LOL, I quickly learned not to do that!

[Putu2Sleep]

then why do we hook up a carrier to levo, if the levo rate is less than 10?

I was taught, and I've seen for myself, that adding ns carriers to drips makes them faster.

it makes them faster initially but the drip is still only going at what the pump is set to for the levophed or whatever you are using. when our fresh hearts come out and say they are on epi @5mcg, levo @ 10mcg, primacor, etc. we still have all that going with a NS carrier at 85cc. Just know that if you increase your carrier up quickly or down quickly it will affect your vasoactives for a short time. but no it does not change the concentration of the drugs in the carrier, just speeds them up to get into the patient.