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PICC LINES

Safety   (4,815 Views | 8 Replies)

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I had a patient come from ICU today with a 2 port PICC and one of them split. He had TPN in one port and protonix and dilaudid in the other that split. I always though TPN had to be in a PICC WITH nothing else going into it, even the other ports. Like TPN in the PICC and a PIV for other stuff. That's one thing I'm confused about. Also, protonix is supposed to be by itself and they brought him up with dilaudid y'd into the same line, which had NS hooked up on its port. Another nurse said they should have put a three port in because the protonix is being diluted. Anyways, I just don't get it. They are all going to the same place and mixing. Can someone help me understand this and if this person should have had three ports?

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sallyrnrrt is a ADN, RN and specializes in critical care, ER,ICU, CVSURG, CCU.

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

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129 Posts; 3,391 Profile Views

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

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Here.I.Stand has 16 years experience as a BSN, RN and specializes in SICU, trauma, neuro.

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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.

Edited by Here.I.Stand
said Dilaudid, meant Protonix

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IVRUS has 32 years experience as a BSN, RN and specializes in Vascular Access.

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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.

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sallyrnrrt is a ADN, RN and specializes in critical care, ER,ICU, CVSURG, CCU.

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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. ;)

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KelRN215 has 10 years experience as a BSN, RN and specializes in Pedi.

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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?

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MunoRN has 10 years experience as a RN and specializes in Critical Care.

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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.

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IVRUS has 32 years experience as a BSN, RN and specializes in Vascular Access.

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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.

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