ICU Nurses I Didn't Know You Could Do This???

Specialties MICU

Published

So being an ER nurse of course we deal with critical patients. So yesterday we had a patient extremely critical, poor prognosis BP is like 40/10, we are maxed out on all pressors.

Pressors are running through the triple lumen. All 3 lumens.

My manager comes in and gives us some tips. He basically stacked three- 3 way ports together one for each pressor on a main line of normal saline and connected it to one of the triple lumens and a heplock to the other end, then connected each pressor to a port.

He said this is for added effect of the pressors and also to free up some lines.

Thank goodness because last patient I had to let each antibiotic wait one after the other because all 5 of my lines (triple lumen + 2 peripheral lines) were taken. I had one pressor on each line, sodium bicarb on another line, and antibiotics on the last line I had.

Also the middle lumen is used for what?

Specializes in Critical Care, ER.

Sometimes you have to get very creative in the ICU. Always verify what is compatible. Bicarb is always tricky. I think precedex is compatible. Our facility uses that a lot for sedation.

Specializes in ICU-my whole life!!.

I hate precedex! It totally blows.

Specializes in ICU.
I hate precedex! It totally blows.

Precedex is great if you want one of the following:

- a toally unsedated ( = wild, tachypneic, combative) patient

- a pt totally snowed on a less-than-theoretically minimal dose of precedex

- a pt who goes from normal sinus (or sinus tach) to a nice brady rate in the 40's

- a pt with a normal heart rate plus (at no additional charge!) hypotension

Specializes in ICU.

You forgot the briefly asystolic patient when someone flushes the line without withdrawing the drug first...

Oh wow, I've never worked with precedex, although a few shifts ago I had an ICU resident order it, when I asked the ER resident if they were familiar with the drug they just looked at me wide eyed with not a clue. Thank fully the ICU resident then d'cd the precedex before I could even look up the drug.

Specializes in ICU.
You forgot the briefly asystolic patient when someone flushes the line without withdrawing the drug first...

It's great when pharmacy sends your Precedex as a bolus dose, plus a dose for continuous infusion....with NO insuructions on how to safely give the loading dose (to be infused over 10+ minutes). If you give the bolus as a "push", let the fun times begin!:redlight:

Specializes in PICU, Sedation/Radiology, PACU.
HI MikeRNWI,

Sorry I am a new grad, is it ok to bolus every for a short time? That will be all the vasopressors and bicarb??? Interesting....

Absolutely not. You NEVER bolus or flush a line with pressers running.

If you have a triple lumen catheter, you bolus through a lumen that is not running pressers.

Our policy is to use the proximal port for pressers, middle port for TPN/Lipids and distal port for transduced CVP and intermittent infusions.

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