confused about Y-ports and IV fluids

[raindrop]

1) Most people use the Y-ports to prevent 2 drugs from mixing. But they do end up mixing when the 2 lines meet and become 1 line. So what is the purpose?

And also, I get confused about compabitlty. Let's say that someone has D5.45 w/ 20 KCL infusing........is it okay to hang a piggyback to this line so long as they are compatable?

In nursing school, our instructor never allowed us to hang piggybacks with anything but NS. If a patient had a different fluid infusing (like D5), we would have to grab a 250 ml bag of NS, attach the PB to that, and set the pump to flush approx 30 cc saline after the PB.

But at my job, people attach PB to any fluids that are hanging as primary.

And if 2 drugs aren't compatable, is it ok to push or hang them immedietely after one another, as long as gthey don't mix? Again, my instructor said the rule of thumb is to wait 30 minutes.......but I never understood why. Omce it hits the circulatory system, the drug is being perfused and there aren't any risks, IMO. Here at work, they don't wait any given time...they just do it.

[Babarnurse]

I don't think the lines become one....I think they have seperate "exits".

[cardiacRN2006, ADN, RN]

If the drugs are compatible, then it's ok to use the D5 .45ns. Just as long as you check compatibility.

It's unrealistic to only have NS as the primary fluid. If you only had one line then you would have to stop the MIV, set up a NS driver and IVPB, run the PB, and then re-set up the MIV, (unless you absolutely have to like if they were on a bicarb gtt or something or you had limited access.)

Plus, if you had the IVPB set up, and forgot to check back on your pt, they could continue to get the NS, or not get their maintenance fluid. Sometimes, something as little as not having the D5 in the fluid can cause low blood sugar in some patients. When I was a tech on a MS floor, I could hear the IVPBs beeping for hours.

And as much as we think NS is a perfectly safe MIV, a lot of pts cannot be on that (like people with hypernatremia)

[AprilRNhere]

Ditto that they have different exit points. The meds are then mixing into blood so it should be fine.

[RainDreamer, BSN, RN]

I don't think the lines become one....I think they have seperate "exits".

Correct. If it's a double-lumen type thing you're talking about, then they have completely separate lines throughout the entire tubing until it hits the patient, then it doesn't matter.

Also, we never wait 30 minutes if they're not compatible, just as long as we flush the tubing in between. It's only so the meds don't mix while in the tubing, but beyond that it doesn't matter, so I don't see why she says wait 30 minutes .... what's her rationale there?

[cardiacRN2006, ADN, RN]

Y ports on regular IVs become one. Only central lines have multiple exit ports, to my knowledge...

[RainDreamer, BSN, RN]

Hmmm, then I don't see why they would use Y-ports to keep drugs from mixing either, if they end up coming together at some point.

[TeresaB930, BSN, RN]

Raindrop, thank you for starting this thread. I have had questions about this as well. Does anyone else have input regarding peripheral lines, Y-ports and compatibility?

Thank you!

[elizabells, BSN, RN]

A number of the meds we give in our NICU have "terminal site compatibility". What our pharmacy tells us is that the amount of space the drugs can mix in at the end of an IV (remember we're talking babies, so it's a 0.56 in, 24g catheter plus a very small amount of tubing) is not enough to cause a problem. We do have some that are totally incompatible, and we have to start another line. One of our NPs actually designed a tri-set that minimizes the amount of mixing space at the end, so we can run TPN, lipids, and a med together.

[meownsmile, BSN, RN]

There is a period of time that if mixed they wont cause a problem. Usually it is because 2 mixed that are incompatable form a precipitate in the line. If you use the lowest Y port, it minimizes the time that the 2 are exposed and it infuses into the system before it reacts. I say again some instances it is ok, however others you can not mix at all like that.

If in doubt consult your literature on the unit or call the in house pharmacy (pharmacist) to see if they have any other compatability information.

Same goes for IV fluids and piggybacks, check the books, lit on the unit and if still in doubt call the pharmacist for help.

[TXstudentRN]

I've used y-ports myself on my single lumen mediport. Unlike tunneled central lines or double lumen picc's where there actually are two exit spaces, in the y connector I'm talking about the meds/fluids meet at the long part of the "Y." However, you can clamp one side of the Y, then unclamp the other if needed. I mainly used these when I was on both TPN and normal saline, which were debated for a ridiculously long time as to if they were compatible, which they are. Same with fluids and antibiotics, except at home. I think they are used in home health a lot more than hospitals because patients have portable pumps and don't want to be piggybacking a lot since the pumps are programmed and generally not able to be changed by the patient. Does that make sense? I'm not a nurse yet, but I've dealt with a bunch of PICCs, mid-lines, and ports on myself over the past few years...

[suanna]

I think people are confusing "y ports" with splip PICC lines or multi lumen lines. A y connector is only seperate to the I.V. hub- after that- it goes through the same line. Many drugs list compatability as "mixed with" or "OK through Y port" "ok to run through" indicating momentary contact isnt a problem but prolonged contact effects the med.