Drips and such

[sharann, BSN, RN]

Hi,

I'm not sure of the right thing to do here. I know every nurse and hospital has it's own policies, but here goes:

Had a pt come to me in recovery room yesturday. The anesthesiologist had one IV site with both a heparin drip and Dopamine drip and normal saline (both dpips on pumps). I told him we needed another line because I was sure I had learned that Heparin goes in alone. He was great and started another line. My question is, he then ordered Albumin 250 cc's stat IV. Where would you run this? Do we need 3 lines? Also, does the Heparin need a "base" solution to be run with it, or can heparin run by itself(pump in use of course). No one here seemed to know. Our anticoag protocol did not address the issue.

Many thanks,

ME

[cannoli]

I don't have the answer at hand to your question, but it seems like so many times things are run together thru the same line at the same time while the patient is in OR without harm to the patient and then when they come out of the OR, everything has to be run through a different line.

What does the pharmacist have to say about your question?

[EastCoast]

DId he order 250cc or albumin or was it hespan??

are you sure it wasn't 25 gm. of albumin??

250cc seem like an awful lot of albumin.

If in fact it was just a small volume of albumin i would interupt the heparin and push it. I was taught you only run compatible/compatible solutions together. I do not recall if dopa and heparin are compatible. As some one said..in the OR everything becomes compatible.

[SmilingBluEyes]

I agree with the poster who said to ask the pharmacist. when I am in doubt, I ask them.......they KNOW this stuff best.

[Tweety, BSN, RN]

Heparin actually has a compatability with Dopamine. I would run the dopamine and heparin together downline y'd together and give the albumin alone. Or interrupt the heparin, as the albumin may cause hypotension.

It's an old nurses myth that heparin is not compatable with anything. It has a few compatabilities including an antibiodic or two. But it is always a good practice to run these type of IVs alone whenever possible as they are delivered at such slow rates, plus it might be your hospital's policy.

http://www.vhpharmsci.com/PDTM/Monographs/dopamine.htm

http://www.vhpharmsci.com/PDTM/Monographs/heparin.htm

[cannoli]

Those are great links. For dopamine it says central line only, is that really standard? They run dopamine on the tele floor, and this was a long while ago that I saw it but someone had it running in their antecub.

By y-site, I take it that means that short piece of y shaped tubing that still has an inch or two of the meds running in together, is that it?

[sharann, BSN, RN]

Thanks all. 3rdshift, I think you are right about nurse myths. There are too many of those. Thanks for the links!

[Tweety, BSN, RN]

Originally posted by cannoli

Those are great links. For dopamine it says central line only, is that really standard? They run dopamine on the tele floor, and this was a long while ago that I saw it but someone had it running in their antecub.

By y-site, I take it that means that short piece of y shaped tubing that still has an inch or two of the meds running in together, is that it?

I can't answer about the standard for dopamine, but I've seen it given peripherally. If it's a life-threatening emergency I don't see withholding it because you don't have a line.

That's what I think of when I think y-site. But also I think the port closest to the insertion site can be considered a y-site as well. Someone please correct me if I'm wrong.

[kmchugh]

From the OR

Yes, we often run a whole lot of things together that would not necessarily be run together elsewhere. But, you do what you have to to keep the patient alive.

Also, a central line is the preferred route for dopamine. If I have a patient I know will be on a dopamine drip, I will either place a central line, or have the surgeon do it before beginning the procedure. Reason is that if the IV infiltrates, dopamine will cause significant harm to the patient. It's literally murder on tissue. However, in an emergency, the rule becomes "save the patient's life first, and we'll worry about the arm later."

Kevin McHugh

[cannoli]

Thanks.

[RNKPCE]

I work tele and we give dopamine in a peripheral IV most of the time. Do I like it? No way. I think dopamine should be given in a PICC or Central line except for extreme emergencies and only until a more secure line can be placed. We once had dopamine infilitrate in mediport( the kind that is under the skin and is accessed with a huber needle., I think that is a mediport),, the nurse didn't access the implantable device properly and it cause major extravasation in the patients chest.

[cannoli]

batmik, I agree with that!