drips connecting at y-site

Zookeeper3 · May 8, 2010

Yes, I'll never forget a peer who hooked his antibiotic into the KVO NS that was attatched at the Y site to cardizem drip. HR of 30's for several minutes.

fiveofpeep · May 8, 2010

I understand that. because you are adding something with a faster rate on top of something with a slower rate...but what if you attach something with a slower rate on top of something with a faster rate...how does that change things?

Im only asking because on occasion I have seen some nurses do this. I have never lacked IV sites enough to consider it, but now that Im on my own I really want to figure this out. Its bugging me

aCRNAhopeful · May 8, 2010

Yeah I was sort of wondering about a similar question this week. I would say that it is fine to run something like NS at a faster rate that is connected directly to the IV site with something going at a slower rate connected to the Y site of the NS. I don't see how the rate of the second gtt would be affected. I think it would slowly drip into the normal saline line and once it reaches there it would get delivered quickly to the patient but be diluted by the normal saline in that line.

The question I had this week regarding Y sites is when is it too much? I had a patient from cath lab with normal saline connected to the IV directly, nitro gtt connected to the Y site of NS, and integrillin gtt connected to the Y site of the nitro gtt. Since all were compatible and I was still able to titrate my nitro and have reliable delivery to the patient via the NS line I did not worry about it too much but just made me wonder. I definately would not have added another gtt to that mess though.

CNL2B · May 8, 2010

This is a common problem where I work. All of our CV surgeries have a Swan, which has 1 infusion port, threaded through a cordis, which is another port to use, and then sometimes they use the CVP port if they have to (but then you have to turn it off to monitoring.) How we deal with it here is get this little extender thingy we call a "chicken foot" - it plugs into the infusion port on the Swan and has 4 little extenders with caps so you can plug 4 different drugs into one port. They are still all going into the same line further down but you don't run into the problem where one drug is pushing another one in.

You CAN run a maintainance and a drip together, like other people said, and it is safer to plug the gtt into the maintainance line (not the other way around) since that is usually going at a faster rate. That way, the drip just gets trickled in via the maintainance. This is not ideal, and you do have to watch if you are then hanging secondary meds onto your maintainance, not just with flow rates, but with compatibility with whatever gtt you are running.

I do think it is fine to run compatible gtts together, especially if they do the same thing (e.g. multiple pressors) and especially it is fine if they are at a stable rate and not titrating much. Drips I specifically worry about are amiodarone (it's not compatible with hardly anything), heparin (even a small flush of that - 3 or 4 ccs - can change your PTT), insulin (another thing you could get into trouble with if you just flush in a few cc's) and really fast acting, potent stuff like nipride. It's best to run that kind of stuff separate if you can. (With insulin, one thing we do end up doing alot is plugging it into TPN below the filter, since that is at a stable flow rate.) You also shouldn't run stuff that have opposite effects in the same line (nitroglycerin, nitroprusside) because you never know what is going in when and what effect you are going to end up with.

sunnycalifRN · May 8, 2010

I understand that. because you are adding something with a faster rate on top of something with a slower rate...but what if you attach something with a slower rate on top of something with a faster rate...how does that change things?
Im only asking because on occasion I have seen some nurses do this. I have never lacked IV sites enough to consider it, but now that Im on my own I really want to figure this out. Its bugging me

You are right to be concerned about this. But, remember, almost all of our drips are "titrate to effect" . . . so when you add another drip to the manifold (and sometimes we have 8 drips running in on one manifold), the added flow will potentially change things . . . then just adjust your other drips, based on your goal parameters.

The only way to avoid this is to use a separate line, which we do sometimes . . . for example, with Xigris.

dorie43rn · May 10, 2010

Its not going to run it at 100 cc/hr because its only going at 2cc/hr. No more then 2cc/hr is being infused, so it doesn't matter what it is running with, thats all the patient will get, 2cc/hr.

fiveofpeep · May 11, 2010

thanks everyone. I feel like I understand this more.

The only time I could see me having to do this is when we have terrible PIV access and Im already using the "chicken feet" (we call em pigtails) and I still am running out of access.

Im glad you all helped me clear this up and added even more tips to boot. thank you. I will keep this all in mind next time I am dealing with the fun puzzle of titrating drips and ensuring compatibility. It really is a fun puzzle :)

littleneoRN · May 12, 2010

We do this all the time in NICU as IV access issues are common. Our TPN usually IS our maintenance fluid. So it would be very common to have, say...TPN, lipids, and dopamine going into a trifuse. The flow rate below the connection is faster, but the dopamine is only being added to the mix at the appropriate rate. Obviously then, no IV push meds go in this line. And you wouldn't want to do this if you were frequently changing the rate on your maintenance fluids. Anything that would cause even a brief change in the rate would cause the drip med that is already in the line below the Y to be bolused to the patient. We NICU nurses are extra cognizant of even small flushes such as 0.2 or 0.3 mLs since this could be an hour's worth of a drip for some of our patients. So, I can confidently tell you this is safe if you're conscious of compatibility and not flushing the line.

RN Joe 86 · Jun 3, 2010

It actually does not matter if the gtt is y-sited in or not. What ever the gtt rate is set is what the pt. will recieve.

jbp0529 · Jun 4, 2010

Here is another thing to keep in mind about y-siting drips:

Lets say you have 4 drips all y-sited together (not with a "chicken foot", but one y sited with another, which is y sited with another and so on). By the time you have them all hooked up, the entry point of your 4th drip is a considerable distance away from your patient (increased dead space). And if that drip is going at a slow rate, lets say 10 cc's/hr, it will take a LONG time to actually reach the patient and produce it's desired affect.

(Levophed)

============== >>>> {patient}

/

/ (Neo)

===========

/

/ (Dopamine)

=============

/

/ (Versed)

===========

So my drawing is crude, but hopefully it will better explain my point. In this case, if you needed to make an adjustment to the versed, the solution will have to travel through all those other y-connected drips before reaching the patient.

When ever I see this at work, I get really upset and put on a manifold or chicken foot device, so that all my drips are approximately equal in distance from the patient.

tri-rn · Jun 4, 2010

What's a "chicken foot"?? In my ICU we generally use stopcocks...and more stopcocks...which also increase the distance from drip to patient, so to speak, although maybe not as much as Y-siting. Can anyone post a pic?