Maximum number of IV meds & lines

Specialties CCU

Updated:   Published

What is the maximum number of medications ( and IV lines ) that can safely be infused to the patient and the priorities and protocols , relating to infusions. Patient will have a 3-4 port central line as a given. Patient needs TPN , Propofol, PRBC's, D5 1/2 NS , antibiotics, Dopamine , Amiodarone , Heparin, BiCarb, IV pushes , and blood will be drawn for labs thru the line. {{ Can a patient have more than one deeply placed IV access }} PS . What ports would be used ( distal vs proximal )

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I am new to ICU so I am very open to correction.

As far as I know, there is no strict limit to the number of medications that can be given through one access at one time. I can see compatibility being the leading issue here though, and that in of itself can severely limit the number of meds you can "stack" into a port.

If at all possible, I save the distal port for CVP readings and blood draws. A three way stopcock can let you infuse, say, antibiotics for 30 min-1 hr then resume CVP readings.

TPN gets its own port but there have been cases where, after consultation with the pharmacists, I have run some riders and IV fluids in with TPN. At my facility, there is no strict policy against it but this is not ideal practice.

According to Trissel's, propofol is compatible with some meds like Lasix but, oh boy, you should see the dirty looks I have gotten for pushing anything into a propofol line. The patient is on a vent, meant to be sedated and I push slow, slow, slow. Still, the looooooks I have gotten the one time I did this.... Eep.

Don't forget to use a manifold. It can greatly increase the number of meds you can give through one port (again, provided they are compatible!).

In some cases, you may still need peripheral IVs. Sucks but that's how it goes.

1 Votes

After some quick research, I learned more about how bad joining TPN with anything can be. It is not so much an issue of compatibility as it is infection control. I can see why the pharmacists OK'd my proposal to join XYZ with TPN from a compatibility perspective, but they are not the ones who are responsible for keeping the line sterile at the bedside.

I would like to hear input on whether joining propofol with other compatible meds is also an infection control issue. If I am changing the propofol bottle and lines within 12 hrs, keep lines sterile and scrub all hubs, is it really an issue?

Sorry for hijacking the thread with my own questions hehe.

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No, typically run propofol/fentanyl/Midaz/ other sedatives all together.

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Specializes in Current: ER Past: Cardiac Tele.

Seeing as you would have a central line, there are certain meds that would definitely need to be in the central line. Of the two you listed TPN and Amiodarone need to be connected to the central line.

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Specializes in CICU.

I don't know if there is a maximum. I do know that there are times when you do the very best you can with the access you have.

I will say that single lumen PICCs are frustrating to me :sour:.

1 Votes
ADeks said:
Seeing as you would have a central line, there are certain meds that would definitely need to be in the central line. Of the two you listed TPN and Amiodarone need to be connected to the central line.

What about dopamine?

If I could only hook up one more med to my central line web-o'-meds, I would choose to put the dopamine over the amiodarone. Amiodarone can cause phlebitis when given through a peripheral line, but dopamine infiltrations are much worse in my experience.

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Specializes in MICU - CCRN, IR, Vascular Surgery.

When I have this many things running, I create a compatibility sheet from our pharmacy page on our intranet. Then I draw a tree with each available lumen and write what's going through each branch to keep it all straight. And with all of these, please make labels at all of the ports that show what each line is. In an emergency, you need to know where you can push meds, and it keeps everything straight when changing lines too.

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Very helpful

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Thank to all comments above, Some of my concerns are fluid overload and I'm of the opinion that once a ( line ) of the central has been used for anything... it could not be available for blood..except in an emergency , necessitating a clean peripheral. am I wrong ? And now lets complicate things a little more ...they are going to need dialysis...huh? Where can they obtain access ..femoral perhaps or can they still access the upper extremities, sub clavian..etc...

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Our facilities policy is no more 3 lines stacked together. If we are running our sedatives together propofol gets stacked last since the tubing is only good for 12 hrs. Had a pt the other day had 13 pumps going, 2 pressure bags. He had a triple lumen IJ, two periphs, a osteo, a femoral that was doubling for a art line, and a vascath that had a pig tale. We use micromedix for comparability. If we don't have lines our docs are wonderful about dropping central lines, femoral, vas caths with pig tails (especially if they see HD or CRRT going to be needed with 24 hrs). instead of TPN can you drop a dobb-hoff and do tube feedings?

Sent from my iPad using allnurses.com

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This is exactly what I'm seeking info on. Please respond with more detail about what was infusing where, what meds you were able to run concurrently, what were the peripherals meds , what was the osteo. what was in the IJ, the pig tail, and of course its ALLL theoreticall and no such patient actualy exists

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