Central line and CVP overview and medications. New grad in icu. Need ICU rn help!

Nurses General Nursing

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Just had some questions. New grad in icu. First day. Most my patients have CVP and on a million drips. So when you have a patient, they are on maint solution. Do most of you meds just hang as a secondary to this? e.g. fentanyl, insulin, versed, dextran. I mean, I don't want any med interactions. Cause say you get an order for a vasopressor (which I understand should be ran in a central line and by itself). So if you run the vasopressor, where are you going to run all the other meds. More peripheral ivs? I know there are 3 ports on the central line but since they all connect to one, you can't run anything else on it right?

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Specializes in ED, CTSurg, IVTeam, Oncology.

If the line is a triple lumen, then each one will open at some distance away from the others, allowing blood to first mix with the infusion before it comes into contact with the other infusions.

Further, if the line was placed through a Side Port (aka Introducer or Cordis), then that can be used as a 4th line. Additionally, I would get in touch with your Pharmacy to find out which meds can be safely infused together, or what can be safely Y-ported. Despite this however, there are some instances where the needs of infusion therapy overwhelms the ability of the existing access and more lines would need to be obtained.

Good luck! :up:

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Specializes in Critical Care.

I hope this ICU has you in a new grad residency or some type of training schedule? Being a new grad in the ICU can be very overwhelming, I'd hate to see them hang you out to dry.

As "Emergency RN" said, a triple lumen doesn't mix inside the line. They are each open into the bloodstream at different places along the line. Consider them to be seperate IV lines. The only time I consider anything "mixing" for a triple lumen is certain labs I won't draw off a triple lumen if TPN is running (not even after flushing, just a personal preference). I also don't draw aPTT off a line, since they are usually coated with heparin.

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See if you have access to MicroMedex at your hospital. They have a tab on the site that checks IV compatibility. List all the IV meds someone is on (gtts, piggybacks and pushes), it'll spit out what is, what isn't and what is unknown re: IV line compatibility. I found that insulin and propofol are compatible.

If you don't have MicroMedex, become great friends with the pharmacist!

Good Luck!

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Here is a pretty good video... watch the end especially OP.

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Stopcocks are your friends in critical care. Screw a bunch of stopcocks all in a row and then you can combine multiple drips onto your manifold. You will eventually learn what's compatible. You should have access to the King Guide on your computer to check compatibilities of IV solutions.

Versed and fentanyl are compatible and can be y-sited into each other and then into your MIVF (if it's compat.). Some of your electrolytes can go together. I typically use my distal port of my CVL for antibiotics, PRN meds, etc.

What you put where will really vary based on the access you have. Sometimes you'll have nothing but PIVs to work with and other days you'll have a triple lumen CVL, a portacath, and a double lumen introducer with a PA Cath that has an infusion port on the PA.

You will learn with time. This is definitely somethign to be asking your preceptor ASAP!

Good luck.

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Meandragonbrett, I'd love to see someone that you've totally lined out. I am sure, it's a work of beauty. I haven't seen anybody do your stopcock ad on deal, am a little afraid of it actually. Great if you knew of a link showing details.

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I am sure, it's a work of beauty. I haven't seen anybody do your stopcock ad on deal, am a little afraid of it actually. Great if you knew of a link showing details.

Here you go... Stopcock Manifold

Another image

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Thanks... and I looked for some more and found how it looks connected... can you say, better be sure and label stuff? LOL. Wow what a production. However, I wonder about concurrent flow if you really need to in crisis. Just how much can you count on getting through a CVL safely (not intending of course every manifold port to be running concurrently). And considering a CVL, big vessel, you are connected to your NS on one lumen and manifold...

Sorry OP, don't mean to hyjack but you are gonna be grabbing a manifold sooner than i will :lol2:

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Specializes in SICU, Peds CVICU.

I hope your preceptor is available for you to talk with about these "procedural" sort of things. I'm not sure what your hospital policy is, so I'll hold off on telling you exactly what to do, but you absolutely should talk with your preceptor about it. A better use of your time at home would probably be learning how the gtts your patients had today worked. What receptors does Levophed work on? Exactly how does it get the blood pressure up? After going up or down on the rate- when will you see a change in the blood pressure? How is Epinephrine different? Why was your patient on Dextran (and not, say, NS)? If your patient's CVP is 2 and (assuming "normal" adult parameters) HR is 120, why is the blood pressure low?

A trained money can write down vitals every 15 minutes, give meds, and hook up IVs. It's not what we do with our hands that makes us good nurses, it's what we do with our brains that saves lives.

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Specializes in SICU, Peds CVICU.
Thanks... and I looked for some more and found how it looks connected... can you say, better be sure and label stuff? LOL. Wow what a production. However, I wonder about concurrent flow if you really need to in crisis. Just how much can you count on getting through a CVL safely (not intending of course every manifold port to be running concurrently). And considering a CVL, big vessel, you are connected to your NS on one lumen and manifold...

Sorry OP, don't mean to hyjack but you are gonna be grabbing a manifold sooner than i will :lol2:

Just out of curiosity, but how do you hook up multiple gtts if you don't use a manifold? And don't you always label your lines? (unless it's just IVF or something) I tried to find a picture of the ones we use, and couldn't -but- they have one-way valves on every port, so there's not a safety risk of, say, Levo, backing up the line instead of going to the patient. It's not really a "production" when you're used to using them, but isn't that true of everything? lol

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