Central line help

[NRSKF]

I am new to PICU, I have a couple questions about CVC/PICC lines. We mostly use double lumen PICCs or triple lumen CVC. In the double lumen PICC I commonly see epi and maintenance in one lumen, fentanyl, versed, and vec in the other. In this case if I need to draw labs and this is my only access what is the process as far as which lumen and which meds do I pause? Also, can someone explain to me how I have things running at a fast rate but I'm not bolusing my meds in the same lumen and/or the other lumen? And let's say I have something I need to give like Zantac do I put it on the quad fuse with my sedation? My guess is I never want to mess with my pressor med, but I need some clarification. Any other info would be great. Thank you!!

[NotReady4PrimeTime, RN]

Good questions. If you only have 2 lumens and you MUST draw labs from that line, you would be pausing your sedation/paralytic and using that lumen. The trick is to adequately flush the lumen with saline so that when you pull off your specimen it isn't "contaminated" with dextrose. You'd have to do this slowly over at least a minute so you don't dilute down your epi. Although the lumens exit on opposite sides of the line, they do infuse into the same vicinity. This can be tricky. Of course, if you're weaning your pressors you may not see much of an effect one way or the other. As for bolusing, as long as your other infusion rates in the same lumen are not changing, drug delivery isn't being changed either. You titrate to effect, right? On the other hand, if you were to give a bolus of anything into the same lumen as your epi, you'd see a bolus effect from it initially, then a bit of a lag, because you'll have pushed the epi in that portion of the line through and the infusion won't have caught up. Intermittent meds should only be given in the other lumen(s); if compatibility is an issue, it may be necessary to bolus whatever isn't compatible with your required intermittent med (antibiotics, diuretics, anticonvulsants for example) to get you over the hump. And naturally you'd want to give those intermittent meds as quickly as their monograph allows to minimize the time the patient isn't getting the offending infusion. Your example of Zantac is a good one. Many places (used to) include it right in the TPN basic solution and it's completely compatible with TPN, so you could just pop it into the burette...

[NRSKF]

Thank you that definitely helped!

[NotReady4PrimeTime, RN]

Glad to help! A lot of our transplant and cardiac kiddos will have a long-term CVL placed and we're always really annoyed when they bounce back to the ICU with their single-lumen piddly little excuse for access. I remember one little girl years ago - I admitted her from the cath lab - she was on ECMO alert and was a notorious hard stick. The cardiologist didn't think to rewire one of the catheters to a CVL so I get her and she's only got a single-lumen, small bore Broviac. The attending barked out a bunch of orders... VBG, cultures, antibiotics, packed cells... oh and we're keeping her intubated... as the child is trying to stand on her head. "And which of those interventions would you like me to do first THROUGH MY SINGLE POINT OF ACCESS????" Many challenges, eh?