IV tubing port selection for Y-site

[DatMurse]

So I have a nurse on my floor who says that if you y-site any multiple bags. NS, LR, multiple antibiotics. that you should use the port closest to the patient(granted they are on a pump).

She would harass the other nurses that would do so. However, I cannot find any evidence to say that this is actually best practice and in my head, these are more lines to cause entanglement and possible disconnection.

If the drugs are compatible, is there actually any reason to do so?

I keep seeing that chemical compatibility can last for up to 24 hours. idk.

[dudette10, MSN, RN]

I'm not understanding your question. Are you asking where you should y-site or are you asking if you should y-site a IVPB at all?

[DatMurse]

I'm not understanding your question. Are you asking where you should y-site or are you asking if you should y-site a IVPB at all?

3 ports on an iv tubing.

1 above the pump. 1 right below the pump and 1 next to the patient.

If you are y siting it, is there any reason that you shouldnt use the one right below the pump.

[MunoRN, RN]

You need to keep in mind the number of mls between where that infusion connects to the patient, and the rate of the "carrier fluid" vs the rate of the y-sited fluid, and the effect of rate changes in the y-sited fluid. If the y-sited fluid is a titrated med, connected 10mls above where it enters the patient, and the combined rate of the carrier fluid and the y-sited titrated fluid is, for instance, 20ml/hr, any change you make in the rate of the titrated fluid will take 30 minutes to reach the patient. In some situations the difference between the ports is not clinically significant, in others it can make a huge difference.

The one port above the pump is actually separate from the other ports since this is the only "secondary" port, which works differently than a "y-site" port below the pump.

[DatMurse]

The one port above the pump is actually separate from the other ports since this is the only "secondary" port, which works differently than a "y-site" port below the pump.

Oh yes, I am very well aware of this.

[IVRUS, BSN, RN]

Not every piece of IV tubing has more than one port. For instance, my pharmacy has the choice of purchasing macro gtt tubing with one port, which would be above the pump housing, for a secondary set, but then it has no other ports along the line. Or, they can obtain a tubing set which has proximal and a distal port, but that tubing is more expensive than the single port, but both are on the formulary.

[firstinfamily, RN]

I would always use the secondary port that is located above the pump, the IV ABTstill needs to be given at a controlled rate. If it is put in the Y site below the pump how do you know how fast it is going and isn't this a risk for "run away" IV fluids?? We would put the secondary IV in the secondary port, lower the main IV bag so that when the secondary is done the primary returns to the normal rate and there is no air pumping in the IV line. If the tubing does not have secondary port what about using a 3-way connector on the extension tubing to create a site for another medication? Then put the secondary bag and tubing in the pump and run it separately from the primary IV?

[SierraBravo]

I've never seen something y-sited above the channel. You always y-site something below the channel, otherwise you are probably going to get an error message on the channel like "occluded, channel side" because of the additional pressure from the additional fluid. The port above the channel is solely for a secondary set to be attached.

[livefully]

Correct me if I'm wrong, but if the drugs are incompatible, the shouldn't be run in the same line, no? And I would use the site closest to the pt to Y-site it in

[runnergirl86, BSN, MSN]

I think you are asking if you have an order for NS 100cc/hr AND NS+10meq Kcl at 50cc/hr to have the NS on the primary line and on a pump, then have the NS+10meq Kcl on another primary line on a pump, and connect them at the y site. Usually it is connected at the most distal y-site, closest to the patient. This is usually done in case there is a reason to stop one of the fluids for an interaction, to give an IV push medication, etc. There is not as much fluid in the line that needs to be run into the patient to return to the primary fluid (NS) as you are already at the most distal port. Also, if you need to give IV Zofran you could stop the NS+10meq Kcl, flush with NS, give Zofran, flush with NS, then turn the NS+10meq Kcl back on.

[DatMurse]

I would always use the secondary port that is located above the pump,

I am talking about Y-Site. not IVPB/secondary

I think you are asking if you have an order for NS 100cc/hr AND NS+10meq Kcl at 50cc/hr to have the NS on the primary line and on a pump, then have the NS+10meq Kcl on another primary line on a pump, and connect them at the y site. Usually it is connected at the most distal y-site, closest to the patient. This is usually done in case there is a reason to stop one of the fluids for an interaction, to give an IV push medication, etc. There is not as much fluid in the line that needs to be run into the patient to return to the primary fluid (NS) as you are already at the most distal port. Also, if you need to give IV Zofran you could stop the NS+10meq Kcl, flush with NS, give Zofran, flush with NS, then turn the NS+10meq Kcl back on.

but why even stop fluids from interacting effect if the chemicals are compatible for 24+ hours.

Wouldnt more iv lines closest to the patient increase risk of entanglement and possible DC?

I am looking for someone to give me an EBP rationale.

[chare]

Wouldnt more iv lines closest to the patient increase risk of entanglement and possible DC?

No. Regardless of whether there is 1 line connected to the IV or 5 lines connected to the IV there is not an increased likelihood of entanglement or dislodging the catheter.

I am looking for someone to give me an EBP rationale.

Both MunoRN and runnergirl86 have given you excellent answers. Remember that often expert opinion is the only information available.