IV extensions

[Dubs3035]

If you already have a PIV running with an extension set and you need more ports to run more meds, can you add a double lumen extension set to your original extension set or do you need to put it on at the hub?

[Dubs3035]

Thx, perfect.

[renardeau, BSN, RN]

Sometimes, I just add a little extension tubing with some stopcocks for this purpose---like a mini-carrier. If my patient is requiring enough drugs for a real carrier bar with ~5 stopcocks to be necessary, they usually have a central line (we usually use them for stuff like multiple pressors anyway) and that lumen generally would only run continuous drips (no IVP or IVPB drugs). And, as people have already mentioned, everything running together would have to be compatible.

[AJJKRN]

Why would you start a second IV?

If that lone IV blows...so could the rest of your shift

I'm assuming the pt is in active childbirth right OP?

[dianah, ASN]

We use those and call them a "chicken foot."

[ATTACH=CONFIG]24590[/ATTACH]

In accordance with hospital policy, of course.

[Cvepo]

I stopcock the crap out of my lines. I walk into rooms with a cluster of tubes all Y-site'd together with nothing labeled, things going together than aren't compatible, etc. One triple lumen, 3 pressors, Bicarb, fentanyl, and heparin gtt -> stopcock the pressors and fentanyl, bicarb gets its own line, the one PIV they have gets the heparin, and boom now I have everything running AND an extra line for fluid boluses, lab draws, etc. Then the previous nurse comes back and is flabbergasted that it only takes a few minutes to get everything running properly. Mmm, I love stopcocks.

[LovingLife123]

Why would you start a second IV?

To have more access, if you have that many meds going through. You should only run three meds at once through one PIV, and you can connect those by the hubs. If you have over three meds, you should get more access.

The only time I have ever seen those connectors used is on a PICC or subclavian. They get very confusing and I find to be dangerous if you are not meticulous on checking everything. I always figure out how to get rid of them. I personally hate them.

[MunoRN, RN]

If that lone IV blows...so could the rest of your shift

I'm assuming the pt is in active childbirth right OP?

If there's indication for a spare IV then that's already in place, adding a new line for meds would be the third line.

[MunoRN, RN]

To have more access, if you have that many meds going through. You should only run three meds at once through one PIV, and you can connect those by the hubs. If you have over three meds, you should get more access.

The only time I have ever seen those connectors used is on a PICC or subclavian. They get very confusing and I find to be dangerous if you are not meticulous on checking everything. I always figure out how to get rid of them. I personally hate them.

I'm curious what your rationale is for your "3 med" rule. There are many factors that determine what can go through a single lumen, but simply the number of components is not one of them.

The type of IV and placement determines what combined rate can be safely and effectively infused, they must be compatible, and the flow characteristics must also be considered, for instance if you have an insulin infusion plugged into a port on an intermittent infusion, then when the intermittent infusion is stopped the entire line below the insulin connection will contain insulin, which means when the intermittent infusion is started up again it will push potentially an hour or more of insulin ahead of it.

As long as the resulting combined rate is appropriate for the catheter and the medication can be safely combined there is no reason why more than three different components can't be combined.

It's important to remember that additional IV access carries risks with it, so there needs to be a legitimate reason to additional IVs.

[canoehead, BSN, RN]

for the OP... Mag and Pitocin may both need to be stopped or bolussed. If you stop one you've just slowed the other, because the driving rate changes. Or if you bolus the magnesium, you are also bolusing about 2cc of Pitocin, depending on where they are connected. You don't want to be in an emergency situation bolusing any amount of Pit. Also, the compatibility of your pain meds might be fine, but what about emergency meds? Or if you lose the IV while shes moving around. I'd STRONGLY suggest a second line, even if its just a saline lock to throw pain meds through. It will make you look like a smart, forward thinking nurse, and it will ward off evil spirits. Myself, I wouldn't start the pit without a second line if shes sick enough to need magnesium.

[AJJKRN]

If there's indication for a spare IV then that's already in place, adding a new line for meds would be the third line.

I'm missing in the posts then where the OP is saying that they have more than one line already in their scenario. I'm reading that the patient only has one IV access but needs more ports to "Y" tubings and other meds into.

[EllaBella1, BSN]

It's important to remember that additional IV access carries risks with it, so there needs to be a legitimate reason to additional IVs.

Eh, I disagree. I think the risk is much higher when it comes to overloading one peripheral site with multiple medications all infusing at the same time. Now if you have a central line that's a different story. I will build a bridge and run every single compatible med together through a central line with no concerns. But when it comes to a peripheral I'll start another one 100% of the time before building any sort of bridge or putting an extra connector to have more lumens. In my ICU our standard of care is for every single patient to have a minimum of two IVs at all times to ensure that you have adequate access. I don't care if both are saline locked at all times. Two IVs. You never know what sort of situation could arise at any moment- if you have a patient who is already on multiple meds running continuously, a second IV is absolutely indicated.