Main IV line

[4ab]

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]

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]

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]

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]

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

[saskrn]

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]

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.

[4ab]

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

[saskrn]

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.

[Urgent]

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

[4ab]

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]

At least for a saline lock