Choosing IV catheter lumen

Nurses General Nursing

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Hi Everyone,

I am a 2nd semester Nursing student facing IV therapy skills. I am trying to find information about what factors to consider when chooses the IV catheter lumen. Tunneled, non-tunneled, Double lumen, triple lumen, quad lumen, etc. What are the guidelines for choosing? :banghead:

Thanks.

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Specializes in CVICU, Burns, Trauma, BMT, Infection control.
Hi Everyone,

I am a 2nd semester Nursing student facing IV therapy skills. I am trying to find information about what factors to consider when chooses the IV catheter lumen. Tunneled, non-tunneled, Double lumen, triple lumen, quad lumen, etc. What are the guidelines for choosing? :banghead:

Thanks.

Well the MD chooses the multiple lumen caths because they are usually central lines. The only kind you'll have to worry about are the angiocaths and they have different guidelines in different areas. Usually the type on a med/surg/tele are for infusion of IV fluid/blood and the sizes are 18g if you can get it in a younger person,20-22g for older folks.

In the ER for trauma pts they try to get larger guage IVs like 14 -16g for rapid administration of blood(thicker than IV fluids).

I hope that gets you started.

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Specializes in NICU.
Hi Everyone,

I am a 2nd semester Nursing student facing IV therapy skills. I am trying to find information about what factors to consider when chooses the IV catheter lumen. Tunneled, non-tunneled, Double lumen, triple lumen, quad lumen, etc. What are the guidelines for choosing? :banghead:

Thanks.

How fast your patient needs vascular access, what staff you have available, what's going to go through the line, how many things need to go through the line, and how long the patient will have the line.

Just take a deep breath and think about what your patient needs. A few days of antibiotics? Chemotherapy? Dialysis? In shock - do they need blood products?

If you do a little Googling, you can find numerous pictures of different kinds of access devices, and it may make more sense.

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I think that I understand needle gauge. It seems fairly straightforward and logical. However, how many ports/lumen do I really need?

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Specializes in Cardiac.
I think that I understand needle gauge. It seems fairly straightforward and logical. However, how many ports/lumen do I really need?

Again, that's totally up to the Dr (or PICC nurse).

You, as a staff nurse will only put in regular, single lumen IVs. Your choices will be limited to size of the IV. If you need more access, then you can place more IVs. But you can't put in multi-lumen ports.

You might want to review your skills lab/clinical info again.

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Specializes in med/surg, telemetry, IV therapy, mgmt.

This is from the most current Intravenous Nurses Society 2006 Infusion Nursing Standards of Practice. These are the standards for IV therapy that most facility policies and procedures are based on.

"Section 38 - Catheter Selection

  • Standard 38.1 - The nurse shall select the appropriate type of catheter to accommodate the patient's vascular access needs based on the prescribed therapy, length of treatment, ability, and resources available to care for the device.
  • Standard 38.2 - The catheter selected shall be the smallest size and shortest length that will accommodate the prescribed therapy.
  • Standard 38.3 - All catheters shall be radiopaque.
  • Standard 38.4 - The nurse shall not alter the vascular access device outside the manufacturer's labeled use(s) and directions for product use.
  • Standard 38.5 - The nurse shall have knowledge of insertion techniques used for the vascular access device.
  • Standard 38.6 - The nurse shall select a catheter with the fewest number of lumens for the infusion management of the patient.
  • Peripheral-Short Practice Criteria
    • Practice Criteria A - The peripheral-short catheter should be defined as one that is less than or equal to 3 inches (7.5cm) in length.
    • Practice Criteria B - The use of a steel-winged infusion set should be limited to short-term or single-dose administration.
    • Practice Criteria C - Peripheral-short catheters or steel-winged infusion sets should be equipped with a safety device with engineered sharps injury protection.

    [*]Peripheral-Midline Practice Criteria

    • Practice Criteria A - A peripheral-midline catheter should be defined as one that is between 3 inches (7.5cm) and 8 inches (20 cm) in length.

    [*]Non-tunneled and Tunneled Catheter, and Implanted Port Practice Criteria

    • Practice Criteria A - The length of the selected catheter should allow for appropriate placement; caution should be used and manufacturer's labeled use(s) and directions should be strictly adhered to when tip alteration is required.
    • Practice Criteria B - If modified to a patient-specific length, the inserted catheter length should be documented.
    • Practice Criteria C - Introducers for percutaneous non-tunneled and tunneled catheters, and implanted ports should be equipped with a safety device with engineered sharps injury protection."

For more specific guidelines regarding the number of lumens to use, I would look into manufacturer/product specs or facility policy.

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Do you have an assignment that specifically asks you to make some choices? LIke the other posters said, the central lines are put in by MDs or anesthesia and the PICCs are put in by PICC/ IV team nurses or interventional radiology. Bedside nurses are only putting in peripheral IV catheters that are 1-2" long and only have the option of a single lumen. If you need more access from there, you will either need to request the MD to order a central line or you will need to add another peripheral angiocath.

Now, as far as multi lumen long lines go... Most of your "input" will be in getting the correct kit for the MD who has already decided. In ICU, the drs do often ask us if we want a line and what we want. Sometimes choices are habit (we never put less than a triple lumen central in pts in ICU, PICC team routinely places double lumens in adults but is starting to use triples if asked in ICU) Really, it will depend on what is happening with your pt. Med Surg pt needs prolonged antibiotics and daily lab draws? A double lumen is fine. Onco pt who will need long term access? An implanted port might be best- it's single lumen is enough but it can be left in place longer than anything else. Typical ICU pt? Several antiobiotics, insulin drip, pressor drip, fluids, multiple electrolye infusions... you'll need the triple as you map out which meds are compatible and can share lumens and what can't. Are you dedicating one port to monitoring central venous pressure? Is he in ICU with significant heart issues? He may need a multi lumen Swan line with ports for CVP monitoring, pulmonary artery monitoring, and cardiac output measuring as well as the many meds.

As far as placement... lines placed by a surgeon in OR are tunneled and you will see an additional suture line when they are new. Lines placed at the bedside are not tunneled. Tunneled lines can remain in place longer for long term home use for chemo, TPN, or temp dialysis.

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Specializes in Oncology.

Man, I want as many lumens as I can get!

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