I just finished my first week of orientation in the ICU. It is going very well, I am just a little confused about compatibility. The patient I was caring for was on several different gtts, all running into the same thing. (I can't think of the name of it, but it has multiple openings to arrange all the lines running into the patient.)
Dopamine
Levophed
Insulin
Epi
Bumex
Versed
Fentanyl
D5.45
So technically all of this was running in together, as it was all going into the patient's cordis. I asked my preceptor if it would be inappropriate to push my other IV meds into the main line and she said it was fine. Is this true?
It is standard practice here in Oz that 99% of ICU patients have an IJ, sub-clavian or femoral multi-lumen central line inserted, or a PICC line if they are a long term patient requiring fewer infusions. The central line would have either three or four lumens. The distal lumen is connected to CVP monitoring, and can be used for IV injections or as an extra line as required. Another lumen is devoted to inotropes. The final lumen (in a triple lumen) has a "traffic light" (multi port attachment) attached, into which the maintenance fluid, fentanyl, propofol, midazolam, precedex, potassium, insulin, frusemide, etc etc is infused. If I am lucky enough to have a quad lumen line, the fourth line will be for a drug that must generally run alone, such as TPN with insulin piggybacked), GTN, heparin, etc. Our bible is the Australian Injectable Drugs Handbook, which details all IV drugs available in Australia, with each drug entry detailing availability, generic/trade names, preparation, administration, stability, compatibility/incompatibility data, and special notes. If I am in doubt about compability, I consult the bible, and then juggle lumens as necessary (and if desperate, insert a peripheral IV).
Be safe just start another piv, heplock it, do pushes through it. And why D5 and insulin togather, I think doc needs to retake that day of pharm.
In the setting of DKA, it's very common to run a Dextrose infusion and insulin at the same time. The primary management concern in DKA is the ketoacidosis, not the hyperglycemia. Insulin gtt is used for ketoacidosis, not hyperglycemia. The side effect of an insulin gtt is hypoglycemia, which is what dextrose is for.
That's why you shouldn't stop the insulin gtt when your patient is no longer hyperglycemic. You wait for the gap to close and the bicarb to rise, and then you stop the drip.
jodyangel, RN
687 Posts
No this is a PIV. I work in Antepartum....not ICU