IV infusion confusion

austin14 · Apr 28, 2011

I might be able to clarigy a little bit. As far as your Heparin question. You would have to either use two different pumps or the pumps we have in the hospital you can run two lines at different rates, but in your example you could not hook up the heparin to the other med because the rates are different. If you did do this then the patient would be getting too much heparin because it would be running at 75 mL/hr instead of 50 mL/hr. If you patient has a tripple lumen then you could hook up to three different lines up to it without worrying about mixig meds. Always look up your meds and check what solutions they are compatible with.

As far as your second question I am not sure. I havent come across that problem yet. Usually if it is time to give meds and they have a IV push and have to hang a bad do the push first and after hang the bag. I dont know if the med is already running but I dont think you would have to start a new IV. Hope this helps some.

MunoRN, RN · Apr 28, 2011

You can run them together on their own pumps and each rate will be correct, resulting in a mix of the two fluids coming out of the IV at 125ml/hr. When changing the rate of the fluid that is y'd in to another drug, or pushing meds through that line, you do need to consider the amount of drug that will be bolused and how that could affect the patient.

Some drugs, such as pressors, must have a line where the base fluid has a constant rate. With heparin, you should Y it in to another fluid as close to the patient as possible, either at the lowest port, or even better at the second port on the IV or using a Y-splitter at the IV port. Whatever the volume is distal to the connection is what could be bolused. If you use the distal port on a line, that leaves approx. 1.5 mls below the connection, bolusing that amount would have no significant clinical effect on the patient. If it's connected to a Y-splitter, there is only a fraction of a ml distal to that point, which would not be much different than amount of fluid that is pushed with each cycle of the pump (pumps don't really run continuously, but rather more of a push/pause).

If the IV push meds were not compatible then you would either start another IV, which could be saline locked between pushes, or you could flush the IV with NS before and after the IV push med, again taking into consideration the amount of med that would be flushed in, essentially as a bolus, as well as the effect of then not having that med infusing during the time that the med is not in the fluid that is infusing immediately after the flush.

glovedgoddess · Apr 28, 2011

Okay, I had the read the responses super slowly and I kind of understand. So this is my understanding...You cannot attach two different solutions by y-site using the same pump if they are going at different rates (that makes sense because you wouldn't be able to set the two seperate rates). BUT, I was speaking about a double pump which has 2 seperate tubing insertion areas and flow rate screens (if I didnt have this I would need to use 2 seperate single pumps, like you were mentioning..correct?) So even though the 2 flow rates are different I can still attach the the 2 compatible sltns or meds via y-site as long as they are running on seperate pumps? :idea:

For some reason I remember another student saying to me that you always need a bag of NS to be hanging when a pt has a Heparin infusion (even if the patient does not have a regular continuous NS infusion ordered). Should I just have the NS hanging there and primed ready-to-go just in case. OR should I hang the NS as the primary line (not running) and attach the Heparin via y-site (only the Heparin running)? :confused:

I hope I am getting my questions across clearly! This is a confusing topic for sure to communicate over typing! I will ask my clinical instructor and nursing preceptor some of these types of things when I begin practicum coming up. Although I have a million questions all the time and I don't want that to backfire on me with my instructor. She is VERY critical!! :eek:

ckh23, BSN, RN · Apr 29, 2011

Okay, I had the read the responses super slowly and I kind of understand. So this is my understanding...You cannot attach two different solutions by y-site using the same pump if they are going at different rates (that makes sense because you wouldn't be able to set the two seperate rates). BUT, I was speaking about a double pump which has 2 seperate tubing insertion areas and flow rate screens (if I didnt have this I would need to use 2 seperate single pumps, like you were mentioning..correct?) So even though the 2 flow rates are different I can still attach the the 2 compatible sltns or meds via y-site as long as they are running on seperate pumps? :idea:

Yes you can run both because the pump will control the flow rate of the NS and heparin. One pump will deliver the NS at 75 ml/hr and the other pump will deliver the heparin at 50ml/hr. However, as Muno stated your total infusion will go up to 125 ml/hr which could be problematic for someone with CHF. Yes if you don't have a double pump you would need to singles.

For some reason I remember another student saying to me that you always need a bag of NS to be hanging when a pt has a Heparin infusion (even if the patient does not have a regular continuous NS infusion ordered). Should I just have the NS hanging there and primed ready-to-go just in case. OR should I hang the NS as the primary line (not running) and attach the Heparin via y-site (only the Heparin running)? :confused:

You do not need to have NS hanging for running heparin. You can run it in by itself.

I hope I am getting my questions across clearly! This is a confusing topic for sure to communicate over typing! I will ask my clinical instructor and nursing preceptor some of these types of things when I begin practicum coming up. Although I have a million questions all the time and I don't want that to backfire on me with my instructor. She is VERY critical!!

Once you start clinical it might help to actually see it being done.

glovedgoddess · May 2, 2011

Thank you!