PICC LINES

three ports are always nice, right now it sounds as if your patient needs another line.....you concern is a good one :)

Ok so are you saying they should have TPN thru one port, Protonix in the other port (PICC) and dilaudid thru a PIV? I guess u figured it was dilaudid PCA, forgot to mention

Two ports=two lumens, so compatibility isn't an issue. As for dilaudid and protonix, I don't have an IV compatibility resource at home (I use Micromedex or Lexicomp online at work)...but if it's not compatible, I would have done one of the following: 1.) If the dilaudid is PCA only or if the pt is a severely difficult stick, I would unhook the Dilaudid for the 15 minutes it takes to run in the Protonix. I'd give the pt a bolus before if any ordered, or have the pt give himself a dose, and then flush with NS before and after Protonix, then hook the PCA back up. Or 2.) if it's a frequent med or one that needs to run over 30-120 minutes plus, for sure start a new line. If that's the case, I'd put the Dilaudid w/ a NS carrier (like 10 ml/hr) in the 2nd port, and then saline lock the new PIV before and after Protonix administration to minimize tubes tethering the pt.

But the TPN is completely fine to run with other solutions in separate ports. The drugs are separated until they hit the bloodstream, and then there is so much hemodilution that compatibility isn't an issue.

SallyRNRTT is correct... What needs to happen now, is placement of a new IV catheter, and yes, I'd advocate for a triple lumen central Line.

The Blood flow dumping into the SVC, where all central lines should terminate (except for those in the femerol), is over 2000mls/min. That is "supposedly" a fast enough rate to decrease mixing of incompatible meds, but honestly, I don't think we have enough studies to determine that with complete certainty. I also haven't read any case where an incompatibility caused someone's demise when given into a seperate lumen of the central line.

my almost 43 yrs. of experience has observed the dilutional effect of the rather significand blood flow thru SVC, is adequate and sequla of incompatable meds have not been demonstrated.

What would the point of having a double lumen PICC be for a patient with TPN if the second lumen couldn't be used? The second lumen is, for all intents and purposes, a separate line and can be treated as such. If the dilaudid is a PCA, why not have the patient hit the button, disconnect it for the protonix infusion, flush with NS and then reconnect the PCA?

SallyRNRTT is correct... What needs to happen now, is placement of a new IV catheter, and yes, I'd advocate for a triple lumen central Line.

The Blood flow dumping into the SVC, where all central lines should terminate (except for those in the femerol), is over 2000mls/min. That is "supposedly" a fast enough rate to decrease mixing of incompatible meds, but honestly, I don't think we have enough studies to determine that with complete certainty. I also haven't read any case where an incompatibility caused someone's demise when given into a seperate lumen of the central line.

Placing additional IV access carries risks and therefore shouldn't be something we do without any good reason.

We actually know quite a bit about the characteristics of incompatibilities and have a good understanding of what would happen given the concentrations, volumes, rates, and flow characteristics of various types of incompatibilities. We also have basic observation. Levophed, for instance is incompatible with a number of other solutions, and many patients with continuous BP monitoring and reliant on levophed will make any loss of the efficacy of the levophed very obvious, yet no implied lack of efficacy has every been reported when levophed is running through one lumen with an incompatible solution in another.

MUNO wrote: "We actually know quite a bit about the characteristics of incompatibilities and have a good understanding of what would happen given the concentrations, volumes, rates, and flow characteristics of various types of incompatibilities. We also have basic observation. Levophed, for instance is incompatible with a number of other solutions, and many patients with continuous BP monitoring and reliant on levophed will make any loss of the efficacy of the levophed very obvious, yet no implied lack of efficacy has every been reported when levophed is running through one lumen with an incompatible solution in another."

No, We really don't have the data on what actually will happen when two drug are infusing into a Central Line and the mix with the brisk blood flow in the SVC. Do we have data on compatibilities, incompatibilities?.. Yes, but that is not what is being explored here.