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Main IV line

4ab 4ab (New) New

At my current unit, it is a practiced to have a main line of NS then we piggyback a secondary line which could be anything like cardizem, heparin, natrecor, dopa, dobutamine and everything else. To me it is a lot of fluid to a patient in a cardiac unit and a big waste of money. The old staff say's it will clog the line but i say no way since it's a peripheral line and not a central line like picc or tlc. i would like to know what practice are you doing in your hospitals.

thanks

Aneroo, LPN

Specializes in Cath Lab, OR, CPHN/SN, ER.

The cardiac unit i did my rotation on does IVPB's with those meds. However, they used tiny lil bags of fluid because of the small amount of fluid they were getting. With a lot of the drugs, it was only 7-10cc/hr. -Andrea

begalli

Specializes in Critical Care/ICU.

We usually have a main IV fluid line for piggybacking meds like abx's and lytes. When the piggyback isn't running, the main fluid either runs at 5cc/hr or, more often, we turn it off until the next piggyback.

Our drips (eg: dopa, heparin, epi, etc) ALWAYS run through their own line completely separate from the MIV fluid line (unless it's a bolus of amio that will be piggybacked, or something like that, we don't give boluses of dopa or heparin, etc). There's just too much margin for error and fluctuation in rates in the main line. You don't use a separate peripheral iv for your drips?

Ours are always central lines - ICU, unless it's an admit that does not yet have a central line and only peripheral iv's. Even then we would use a separate site for the drips. For example, esmolol and nipride for a dissecting anuerysm would run through it's own piv while there might be a main fluid running with mgso4 or whatever piggybacked through it in another site.

begalli

Specializes in Critical Care/ICU.

Also, when the piggyback is running, the main fluid and rate does not run at the same time. So my patient is only receiving the mls/hr for the med and not any main fluid at all until the piggyback runs out and the pump kicks back over to main.

Aneroo, LPN

Specializes in Cath Lab, OR, CPHN/SN, ER.

You don't use a separate peripheral iv for your drips?

.

I remember seeing some patients with PIV, but most of them had poor access anyways (except the 40yo addicts). I had some patients who had a PICC or IJ with a few lumens. A lot of the patients I remember seeing only had a few drips, usually either natrecor or heparin (this was a cardiac intermediate unit). I don't recall exactly now about how many accesses they had (was only on the floor for a few weeks). -Andrea

With a peripheral line, if the drug running was at, say 10cc/hr, then we would have some NS, for example, running at TKO to keep the IV patent. Not really alot of fluid running.

Dixielee, BSN, RN

Specializes in ER.

I always have a main IV of NS running at KVO rate in case of emergency. If a BP suddenly drops, you need to be able to open your fluids, and not waste time getting another line or spiking fluids. Also, if your patient is on a NTG, dopamine, or whatever and the vital signs taken a sudden turn, you can turn off your drips above the main line and they will not get anymore of the drug. You can immediately have your maintenence fluid ready to go. If you have your main fluids at 20cc/hr it will keep the vein open but not add appreciable extra fluid. You of course, would modify this if you had a anuric patient on dialysis, but then you would probably have more concentrated drips thru a central line.

is it a policy in every hospital to have this main line or just a practiced that is being done?

is it a policy in every hospital to have this main line or just a practiced that is being done?

I used to travel nurse, so have seen many different units. In some, it's policy, in others it isn't.

Do we need to obtain a physician's order to hang the NS at TKO? Thanks!

Do we need to obtain a physician's order to hang the NS at TKO? Thanks!

i don't think you need an order for a kvo line. not where i work

Aneroo, LPN

Specializes in Cath Lab, OR, CPHN/SN, ER.

At least for a saline lock

Do we need to obtain a physician's order to hang the NS at TKO? Thanks!

You need an order for any IV, unless there is a policy/protocol in place to cover you.

Dixielee, BSN, RN

Specializes in ER.

It depends on where you work about a specific order. I work in ER and almost everyone gets an IV. It is standard protocol for certain complaints. When I worked ICU, it was standard practice to have a maintence line running with drips. It does vary for place to place though.

BY LAW (at least in the U.S.), starting an IV generally requires an MD order (not sure about NPs and PAs, and laws vary from state to state for them). Places where RNs "start an IV without a doctor's order" is not quite true; they start an IV with "standing orders" and "protocols". These are what make it possible for an RN to run a code in some places, and make it possible for paramedics to do whatever they do in the field without having to call the doc for everything--because there are standing orders.

NurseFirst

It depends on where you work about a specific order. I work in ER and almost everyone gets an IV. It is standard protocol for certain complaints. When I worked ICU, it was standard practice to have a maintence line running with drips. It does vary for place to place though.

zacarias, ASN, RN

Specializes in tele, stepdown/PCU, med/surg.

The hospital I worked at before always had a main NS TKO line where vanco, electrolytes would be piggy backed in. You always were safe to have a patent line that way.

Now where I work they don't usually do that. They just hang whatever they hang and then piggy back. I see benefits to both ways as far as cost and time but the NS TKO is probably most "clinically" beneficial.

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