Infusion of Meds Question

[Ravenclaw_RN]

I'm new to the ICU and I have a question regarding infusion of medications. I'll use a recent patient as an example. My last patient only had a trialysis catheter (two ports being used for CRRT) and a double lumen PICC line as his only access. When I came on shift, the night RN had a unit of PRBC infusing into the open lumen of his trialysis catheter and had a three-way "valve" attached to each of his PICC lumens. One of these three-way valves had levophed, vasopressin, and fentanyl attached and infusing through the lumen and the other lumen had two open hubs and calcium gluconate infusing through that lumen. We were using the two open hubs on the second lumen to IVP antibiotics or infuse other medications, like albumin, through. 

I have two questions. 

Is it okay to have fluids/medications infusing together in that type of setup? There never seems to be any worries about compatibility of medications being given. Even though there are three hubs on the valves, those fluids are still running together through the lumen. 

Do you give blood or other blood products through a dialysis catheter? I came from a med-surg unit and we never infused anything through the dialysis access. We would leave them alone (besides maintaining dressings) and let the dialysis nurses deal with it. 

There is just so much to learn and so many new things. Thanks

[JBMmom, MSN, NP]

The open lumen on the dialysis triflow is a viable access to infuse blood or medications. As long as you don't use the two dialysis dedicated lines (which in our hospital are packed with sodium citrate after each treatment), there's no problem. 

For the medications on the three way stopcock, levophed, vasopressin and fentanyl are all compatible. Do you check lexicomp for compatibility of meds? As you mentioned, even on the stopcock, compatibility is important because all of the fluids will mix in the portion of the lumen after the stopcock. 

It sounds to me like the second lumen could just be a KVO with piggyback for things like calcium gluconate, albumin and antibiotics, unless those are scheduled at the same time. Again, you can check compatibility on lexicomp.

[marienm, RN, CCRN]

I check compatibility all the time on Lexicomp. Hopefully your co-workers do too, but it doesn't hurt to double-check it at the beginning of your shift to make sure the setup the previous nurse left I works. Definitely check when new meds get ordered.

If you hospital allows it, you can also infuse certain meds via the CRRT tubing (either pre- or post-filter, depending on the med). We commonly run heparin gtts this way, or blood. (We usually have dual-lumen vas-caths, no third lumen available.)

[PaSSiNGaS, MSN]

Most meds are compatible with the small percentage of drugs being NaHCO3, Lasix, and some other rare combinations.

In regards to a dialysis catheter they are some of the biggest gauged access lines you could ask for and are amazing to use especially when you want to give blood products very quickly.  If you need to use one because you don't have other access the biggest thing you want to do is pull off blood to waste because many times the lines are flushed with Heparin.  There are usually numbers on each lumen (1.5 or 1.7cc) and this is the amount of heparin in mLs that the dialysis nurse will sit into the catheter to prevent it from clotting.  So as long as you pull off 5-10ccs of blood to waste before using it it should be just fine.

[LovingLife123]

Your question is exactly why I hate trifusers.    People don’t realize you have to check compatibility.  Now, Levo, Vaso, and Fent are compatible which tells me your coworker did check.  I would have done the same by running the blood on the third port of the dialysis cath, the calcium gluconate on a line of its own, then the other 3 together.  

[0.9%NormalSarah, BSN, RN]

If I have a ton of meds, drips, and limited access, I’ll print the compatibility report off lexicomp or micromedex and tape it up by the computer or pumps.