Central line compatibility

Specialties Critical

Published

So yesterday, I an ER nurse brought a patient to ICU with just respiratory and me. Which is fine. When I get up to ICU the director is waiting for me, and yelling at me for having levophed and NS with bicarb going through two different ports of a central line and how they're not compatible. Then the rest of her nurses belittled me about "oh did someone forget that?" And they all laughed. Humiliating, sure. Frustrating? Very. Anyway, I came here to get some insight from some fellow nurses, aren't triple or double lumen lines like a CL or a PICC designed so that noncompatible medications can go through different ports without having to start new lines on patients? I did not have these Y-sited in. They were through different lumens/ports whatever you want to call them. Was I wrong?

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So yesterday, I an ER nurse brought a patient to ICU with just respiratory and me. Which is fine. When I get up to ICU the director is waiting for me, and yelling at me for having levophed and NS with bicarb going through two different ports of a central line and how they're not compatible. Then the rest of her nurses belittled me about "oh did someone forget that?" And they all laughed. Humiliating, sure. Frustrating? Very. Anyway, I came here to get some insight from some fellow nurses, aren't triple or double lumen lines like a CL or a PICC designed so that noncompatible medications can go through different ports without having to start new lines on patients? I did not have these Y-sited in. They were through different lumens/ports whatever you want to call them. Was I wrong?

NO, you were not wrong. The fact that they would question that makes me seriously question THEIR competence.

I would file an incident report against them. If there is some backward facility policy backing the, that policy is WRONG and they need to change it.

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Sounds vaguely Kafkaesque.

Answer 1a: Yes, central lines are designed so that non-compatible medications can be run through different lumens at the same time. Each lumen has its own discreet path through the catheter until exiting into a large blood vessel.

Answer 1b: The nurses in an ICU know this. We couldn't do our jobs without knowing this. Maybe if it was just one newbie berating you, we could chalk it up to a mistake on her part, but not a whole bunch of ICU nurses. So I'm wondering if something was lost in translation here. Are you certain you were administering the medications through different ports of a central line, and not just through something like a y-connector or stop-cock rig hooked up to a single port? I know I've seen nurses administer non-compatible medications through a y-connector hooked up to an EJ (peripheral) line, falsely believing that the y-connector made it two different ports.

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Specializes in Pediatric Hematology/Oncology.

It's probably just because the "OMG it's bicarb stop ALL the things!" knee-jerk reaction to the bicarb drip. As the above posters mentioned, you weren't wrong. The ICU was just throwing a hissy fit for no good reason.

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Specializes in Critical care.
It's probably just because the "OMG it's bicarb stop ALL the things!" knee-jerk reaction to the bicarb drip. As the above posters mentioned, you weren't wrong. The ICU was just throwing a hissy fit for no good reason.

Surprisingly bicarb drips are compatible now with a large number of our ICU drips. Yes they were wrong, you were right. The key here is .... it was the ICU director, bringing back that old saying .... "If you can't do, then manage" The floor staff may not have felt comfortable contradicting their bosses boss in public, or they all rode the short bus to work.

Cheers

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Answer 1b: The nurses in an ICU know this. We couldn't do our jobs without knowing this. Maybe if it was just one newbie berating you, we could chalk it up to a mistake on her part, but not a whole bunch of ICU nurses. So I'm wondering if something was lost in translation here. Are you certain you were administering the medications through different ports of a central line, and not just through something like a y-connector or stop-cock rig hooked up to a single port? I know I've seen nurses administer non-compatible medications through a y-connector hooked up to an EJ (peripheral) line, falsely believing that the y-connector made it two different ports.

Yss. I'm 100% sure I had it in separate ports. One blue, one red. I assisted with the central line placement and then after X-ray hooked it all up. I did have saline running with potassium Y sited in, I guess it is possible that she saw that y site and assumed it was that one. I mostly did not appreciate the director speaking to me the way she did in front of her staff. Even saying "are we getting forgetful in our old age?" I'm 28! Although my age shouldn't matter...

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Yss. I'm 100% sure I had it in separate ports. One blue, one red. I assisted with the central line placement and then after X-ray hooked it all up. I did have saline running with potassium Y sited in, I guess it is possible that she saw that y site and assumed it was that one. I mostly did not appreciate the director speaking to me the way she did in front of her staff. Even saying "are we getting forgetful in our old age?" I'm 28! Although my age shouldn't matter...

In that case, I'd guess Hawaiicarl is probably right - the director of the ICU is off her rocker (why was she even involved in the first place?) and the other nurses didn't want to publicly point out that she was full of ****.

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Were that me, I'd demand that they write up the error and make sure that they knew that the director of pharmacy, my medical director and the medical director of the ICU would get copies and get a chance to weigh in.

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Specializes in Critical care.
Were that me, I'd demand that they write up the error and make sure that they knew that the director of pharmacy, my medical director and the medical director of the ICU would get copies and get a chance to weigh in.

I agree. It's one thing that a fundamental bit of nursing knowledge was lacking in the very group that one would expect to understand, it was how it was handled that would make me want to see them "educated".

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Specializes in Critical Care.

You're right. They're wrong.

Why was the director waiting for you in the first place? She sounds lovely.

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She's a staff member recently appointed to management. She was out at the nurses station when I arrived and just came in to help transfe the patient from the stretcher to the bed. Ive never had a problem with her before this í ¾í´”

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You were not wrong. Sounds like the manager was trying to make herself look important and all knowing in front of her staff when all she actually succeeded in doing was making herself look incompetent. I would report the incident to your manager but do so in an email so that you have written confirmation that you reported it.

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