New grad-IV question

[Tds5110]

Hello!

As stated I am new grad, and I was just hoping some of you lovely people could help me answer a question. I work in a PICU, and in my hospital we use the two bag method for DKA patients. One bag that is NS and one that is D10 plus all the additives. My question is on how to set this up considering insulin will be running too. Can I use the NS as the primary line, and then Y-site in the D10 and insulin drip using two separate pumps? What happens if we are adjusting the two bags and the NS is completely shut off, will the other two continue to flow at their own rates because they have their own pump? Sorry if this is a stupid question, being a new grad can be very frustrating trying to figure out all these little puzzles when you've never seen it before.

[marienm, RN, CCRN]

I don't work in a PICU or (presumably) at your hospital, so take this with a grain of salt:

1) Check with pharmacy or a database (we use Lexicomp) and make sure all the stuff you want to run is Y-site compatible.

2) My hospital uses Alaris pumps. The way these pumps work is there is one central brain with up to 4 channels attached. Each channel gets one whole set of IV tubing that fits in the pump and has a roller clamp below the pump (just in case) as well as a luer-lock about 6" from the end of the tubing. This meand you could screw the tubing from one channel (maybe your NS) directly to the pt's IV and then screw the tubing from a different channel to that luer-lock hub and they'd both infuse into the same IV at the same time. Turning off one channel (or closing the roller clamp) would not prevent the other channel from running. Obviously, if you closed the clamp that channel would alarm until you either turned off that channel or opened the clamp.

3) You could Y together as many channels worth of tubing as you wanted; each would be about 6" further away from the patient than the last...which is why you should consider using a stopcock (3-way connector) closer to the patient to connect your critical drips. Imagine: Your patient's BG is high and you use only the Y sites to connect the tubing. The insulin happens to be the last one you connected, so it's 12" from the patient. Our insulin bags are 1unit/mL, so there's maybe 10-20mL/hour running (not a high rate of flow)...it'll take an hour or more before the 1st drop of insulin even enters the bloodstream! I you put a stopcock closer to the patient, the rate of insulin flow will be more consistent.

Does that make sense? You posted a few days ago, so you might have mastered all this by now!

4) For accuracy, I will point out that the Alaris tubing also has a luer lock above the pump where you can connect a secondary med. You can program the channel for the right rate of fluids (100mL/hour for your antibiotic or whatever) and also program the primary rate of fluid to keep running after the med is done. However, the bag for the secondary med must be physically higher than the primary bag....gravity is what makes the 'right' bag infuse....and this is why a critical drip is never hung as a secondary med.