Dedicated med lines

[umcRN, BSN, RN]

I just wanted to get a sense of what other facilities do with their dedicated med lines that are attached to central lines that may have other things running through them. For instance if you have a patient with a PICC that has Maintenance fluids (not TPN), say milrinone and then your med line. Obviously we will assume if a med you are giving is not compatible with the milrinone you either turn the milrinone off briefly or give said med elsewhere.

My question is whether you cap the end of the med line with a needle less adapter In the NICU at my hospital, where I originally trained, we put a blue needle less port on the end of our med lines. Thus when giving meds we would scrub the hub, wait to dry and then give said med. The unit I work in now, historically, does not put any cap on the end of the line but leaves a flush hooked up to it. When you have to give a med you unhook the flush while simultaneously trying to clamp the end of the line to prevent air entry and drip med into port to "top off" and prevent air entry and then screw on the med. Med is given via syringe pump then process is repeated to flush the med. Meanwhile, there is nothing to scrub really when trying to prevent contamination

In my practice, since it is what I was taught, I continue to put a blue clave on all my med ports but this is not routine practice. Our unit practice council is actually working to make it routine but that is really only due to a recent spike in CABSI which in reality cannot necessarily be directly linked to this med admin method since that is how they have been doing it for years.

Thoughts?

[NotReady4PrimeTime, RN]

Whenever possible we run our intermittent meds into our CVP via dedicated tubing. That eliminates the opening and closing of the line multiple times in a shift. If we don't have that option we'll avoid giving meds through lines that have vasoactive infusions going to reduce the possibility of swings in BP. We'd consider milrinone to be in that category. We also try not to run anything in with our TPN due to sepsis risk. But if that's the only choice we've got then we'll interrupt the TPN/lipid infusion (whatever isn't compatible), flush the line, give the med and flush then restart the TPN. We only use Claves on our ECMO circuits. Our bedside carts are stocked with Baxter Interlink components but no one was ever properly educated on their use (like the fact that they have to be primed before they're put on the line! I'm not kidding!), most people don't like them and usually if a patient has an Interlink port on their vascular access - whatever they have for that - it'll disappear to be replaced by a stopcock and a dead-ender. I've tried for 10 years to change this practice and have decided to stop beating my head against the wall.

[harryalexx]

The only thing I'll add to what janfrn said (as my unit is quite similar):

The med lines we use have a slide-clamp. We recently (2 years ago?) standardized its location to be between the tubing expiration label and the hub of the med line (or gtt line). That way, you can clamp the line to prevent air entry, scrub the hub of the line per protocol, top off with saline, and administer the med.

I'm involved with the CLABSI/PI stuff on my unit, and our CNS recommends not using needless adapters (like you're describing) due to the risk of air entry as well as pathogen entry. I know they have fancy ones that claim no chance of air trapping and antimicrobial plastic pieces, but the most basic setup is also the easiest to manage and monitor.

As janfrn mentioned, vasoactive infusions are not interrupted for medication administration. Peripheral access is more likely to be obtained than interrupting milrinone or other infusions for a medication. The only exception is that we run our electrolyte replacements "in front" of our drips if needed. I personally don't like this if it's avoidable, as a neonate with MIVF running at say 3mL/hr will have a change in BP if there are multiple gtts going. The change in rate causes swings in my experience.

Hope that helps.