Cleaning up lines

jamisaurus · Mar 28, 2015

I understand how this is overwhelming, and sometimes your lines will never look clean (due to so many) and you just make it look as nice as you can.

Start one place at a time-- with your CVC. check compatibility and combine what drips you can. Remember, whatever is secondaried in will be pushing the drug before it in so make sure your rates are similar or the slower drug is the one secondaried.

Then go to your CVP, a, line, bladder monitor. You can feed the pressure bags under the wires so you never have to untangle anything, or you can unplug QUICKLY! if you must. I always loop up cords that are really long and hang them from our monitor hooks or tape them so they're not in the way and more liable to catch. This will take time and it's good you're thinking about it. But if you go one line at a time it's not so overwhelming.

nursingjudgment · Mar 28, 2015

Thanks, Jamisaurus! I hadn't though about the secondary pushing the primary in and that's a great point! I do tend to find CVCs overwhelming, since there are multiple lumens and often several drugs per lumen.

When checking compatibility of drugs, do I need to check across lumens? So for example if I have a triple lumen R IJ and I am running levo and vasopressin in one, and then fentanyl and K+ in another, do I need to check the compatibility of K+ with levophed? Or do I only need to check its compatibility with the drugs running into the same lumen?

Nalon1 RN/EMT-P, BSN, RN · Mar 28, 2015

...When checking compatibility of drugs, do I need to check across lumens? So for example if I have a triple lumen R IJ and I am running levo and vasopressin in one, and then fentanyl and K+ in another, do I need to check the compatibility of K+ with levophed? Or do I only need to check its compatibility with the drugs running into the same lumen?

Only in the same lumen. Once they get to the bloodstream it does not matter.

Some may say PICC lines make a difference since all the lumens end at the same point, but it still ends in the bloodstream. I have never seen or heard of problems with it.

Editorial Team / Admin · Mar 28, 2015

I don't work critical care (I'm cardiac OR), but I do frequently drop off and pick up patients in ICU. Unfortunately, completely untangling lines is often an impossible task. Best thing is to label lines- both on the line itself and near or even on the port it's infusing into. If a drip is discontinued/weaned off, don't leave the partially emptied bag connected- go ahead and disconnect it to get the extra line out of the way. Keep it handy if it needs to be restarted, but caps were created for a reason, and it doesn't take that terribly long to reconnect. We also use multiple IV poles when transporting patients- if it's going into a central line or the swan, it goes on one of the two poles at the head of the bed. If it's going into a peripheral IV, it's on one of the two poles at the foot of the bed.

Nalon1 RN/EMT-P, BSN, RN · Mar 29, 2015

I don't work critical care (I'm cardiac OR), but I do frequently drop off and pick up patients in ICU. Unfortunately, completely untangling lines is often an impossible task. Best thing is to label lines- both on the line itself and near or even on the port it's infusing into. If a drip is discontinued/weaned off, don't leave the partially emptied bag connected- go ahead and disconnect it to get the extra line out of the way. Keep it handy if it needs to be restarted, but caps were created for a reason, and it doesn't take that terribly long to reconnect. We also use multiple IV poles when transporting patients- if it's going into a central line or the swan, it goes on one of the two poles at the head of the bed. If it's going into a peripheral IV, it's on one of the two poles at the foot of the bed.

I hate when my patients come back from a procedure. The lines are straightened out before they go, but 95% of the time when they come back, they are a mess. I just don't get that. :no:

IV lines tangled with monitor cables all twisted up in gowns and sheets. Takes me at least 30 minutes to get it straightened out when they get back.

But I do agree, get the unused lines off there. I like using the 3 way stopcocks when I have multiple drips. Hook 3 together and you have 4 access ports, on a triple lumen, gives you quite a bit of ports (still checking for compatibility through on the same lumen). This makes it easier to disconnect lines that are not used and don't have to figure out what y's into what when changing tubing (like when your NS tubing expires that has 3 other drips going into it, having to pause them all while you change tubing).

ausrnurse · Mar 29, 2015

This is one of those things that just gets better with experience. First, I pull down everything that's not being used. For example, all our patients come back from theatre with noradrenaline and GTN running (why??). You're obviously only going to need one of these, so get rid of the other. They also inevitably have insulin running, diabetic or not (again, why??), get rid of this if you don't need it. Check your compatabilities. Inotropes always on their own lumen, and whatever your unit policy is for the rest. Untangle the CVP and art line, then move on to your pressure cables and monitoring. If they've been in theatre, no doubt your central line has somehow become looped six times around your ETT, so it does take a bit of time figuring it all out, and for safety reasons you need to.

nursingjudgment · Mar 29, 2015

I like using the 3 way stopcocks when I have multiple drips. Hook 3 together and you have 4 access ports, on a triple lumen, gives you quite a bit of ports (still checking for compatibility through on the same lumen). This makes it easier to disconnect lines that are not used and don't have to figure out what y's into what when changing tubing (like when your NS tubing expires that has 3 other drips going into it, having to pause them all while you change tubing).

Thanks for the response! Again, I'm new so I think I'm having trouble picturing what you're describing! Are you saying that you connect three 3-way stopcocks together on the same lumen?

FlyingScot, RN · Mar 29, 2015

It's called a manifold. There are some that are manufactured this way or you just screw together however many you need and attach to your lumen.

Nalon1 RN/EMT-P, BSN, RN · Mar 29, 2015

It's called a manifold. There are some that are manufactured this way or you just screw together however many you need and attach to your lumen.

Yup, thats it.

We don't have the pre-made ones where I work so we have to make our own.

Like I said, these greatly help with line management since you can have most everything hooked up to it's own access port. Pause 1 drip, disconnect and untangle the line and hook it back up and restart, can be done in 5-10 seconds, repeat till they are all untangled. Also with your lines labeled at the distal end, you can easily see whats running in a particular lumen without chasing lines up to the y.

nursingjudgment · Mar 29, 2015

Yup, thats it.
We don't have the pre-made ones where I work so we have to make our own.
Like I said, these greatly help with line management since you can have most everything hooked up to it's own access port. Pause 1 drip, disconnect and untangle the line and hook it back up and restart, can be done in 5-10 seconds, repeat till they are all untangled. Also with your lines labeled at the distal end, you can easily see whats running in a particular lumen without chasing lines up to the y.

Oh my goodness, that is frickin' amazing. I can't wait to try that.

NPOaftermidnight, MSN, RN, NP · Mar 29, 2015

This is one of those things that is going to get a LOT easier with time. Other have given you good advice, so I'm just going to leave you guys with this article. :)