CVC's and # of Lumens

[blondy2061h]

I work on a very busy unit where nearly all of our patients' meds are IV and literally everyone has a central line.

I've seen CVC's with 2-5 lumens.

It's not uncommon for this to be a typical med list for a shift:

TPN

PCA pump

Insulin drip

IV cellcept and prograf (over 2 hrs each)

maintenance fluids

IV vanco

IV zosyn

IV anidulafungin

IV acyclovir

IV protonix

IV zofran

IV reglan

IV ganciclovir

IV lopressor/hydralazine/dopamine/something for their BP be it high or low

Plus multiple blood/platlet transfusions throughout the shift...

It makes me think there's a special place in hell reserved for docs who give out patients double lumen CVCs- especially if they have pre-existing conditions coming into the transplant. It sometimes has me deciding if I should transfuse them for their 7.0 hgb or give their immunosuppresans on time. They usually end up getting a double lumen PICC later on in the game (when they're generally less stable and we're realizing we don't have nearly enough access) when they only have a double lumen CVC.

So here's my question. I can't find anything suggesting benefits of double lumen over triple lumen. Why would they even think of just doing a double lumen? Are triple lumens riskier?

[iluvivt, BSN, RN]

There is really not that big of a cost difference between a DL and a TL CVC. On the PICC products we use the TL is only 30$ more than the TL. This is the case with all the product lines I have seen. We place Triple lumen PICCS in all our ICU patients for the most part. We checkk on everything the patient is receiving or likely to receive,based on dx and current condition. You need to speak up if you are unable to give your prescribed therapies on time with your current access. We have many pts with 2 triples or a triple and a dual combo. They need morr we put them in. It is true the more lumens you have the more portals of enrty you have for bacteria..but if you need them you need them..and just take excellent care of them. Also must consider the skill of the inserter and quality of the vein. With bedside Ultrasound we can actually see the size of the vein and determine whether a certain size would be appopriate and provide enough hemodilution.