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 )

I don't quit understand what you're aiming at here. You run things that are compatible wherever you have to run it...end of story.

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nursebettee said:
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

Umm your hospital/pharmacy should have a reference for checking compatibility. Use that.

Do not use an online forum to check compatibility if you value your license/job.

Our hospital uses Micromedex. You can buy that if you don't have access to another reference.

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I don't remember all the drugs. I know he had 4 pressors,electrolytes,NS,cardiac meds, heparin at one point,antibiotics,sedation,pain meds. The osteo I was referring to is actually a intraosseous line. Are you doing a paper? Micromedix is your best bet for compatibility.

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ICULINDA said:
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?

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If all meds are compatible, what is the rationale for not stacking more than 3 into one port? Is it a volume issue? What if the 3 meds are low volume drips? Thanks.

1 Votes
\ said:

If all meds are compatible what is the rationale for not stacking more than 3 into one port? Is it a volume issue? What if the 3 meds are low volume drips? Thanks.

What I was taught is the farther you connect the port the longer it takes to get to the pt. In some cases we have done four when we had no other option and the other meds could not be stopped. I don't think it is a compatibility issue but more of a time it takes to get into pt thing. I'll double check though. Great question!

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Quote
What I was taught is the farther you connect the port the longer it takes to get to the pt. In some cases we have done four when we had no other option and the other meds could not be stopped. I don't think it is a compatibility issue but more of a time it takes to get into pt thing. I'll double check though. Great question! Sent from my iPad using allnurses.com

If I have a few meds I will stack them by using alligator clips and connecting to the IV line. If it gets to be too cumbersome, I typically choose to use a bridge and connect everything with stopcocks right beside my access. Add a flush line to the end and everything flows right through.

Last week I had a patient on a hotline (fluid warmer, pt admit temp was 81 F) and a bicarb drip, so that took two of my lines. I ended up bridging 6 other medications together on the third. Sometimes you just have to make it work the best you can.

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Thank you for your contribution, very helpful

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Could you please elaborate on that. Thank you

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Pressors are usually all compatible. Stack them all together on a CVL port. Next find compatibilities for your other 2 ports. Draw blood through the non- life sustaining gtt lines. If you got a CVP, use it for blood draws and IVPBs. If you have not vesicant meds, run them through peripherals if not compatible. Get as many peripherals as needed. If poor IV access, get another CVL and start from beginning

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
nursebettee said:
Could you please elaborate on that. Thank you

Voice of experience here.....there is no limit per se.

You run compatible meds together. TPN gets a designated line. I've had patients with 3 or 4 introducers with a couple of multi lumens and add a infuse port PA line.

Things that make the B/P go up in one line. TPN in it's own line sedation in another. Designated IVPB/bolus line and/or blood line. I've had patients with 14 pumps. What goes where depends on what is being monitored and what is being infused. and yes they can still have dialysis usually CVVHD with a fem line....or a subclavian Vas cath. add a balloon pump and/or a vad....and you have a sick patient.

Fluid overload? You concentrate the drips where possible....give lasix and monitor the patient carefully.

What specifically are you asking.

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What is the rationale for TPN having a designated line?

I have had a pt with a CVL that had one lumen for sedation, one for pressors, and the third for TPN. I called pharmacy to ask about compatibility for abx and they always say just run it with the TPN.

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Specializes in Critical Care.
walkingthecow said:
What is the rationale for TPN having a designated line?

I have had a pt with a CVL that had one lumen for sedation, one for pressors, and the third for TPN. I called pharmacy to ask about compatibility for abx and they always say just run it with the TPN.

Because of the high risk of infection due to the dextrose in the TPN.

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