Kate96

Those are all fair points! I have never witnessed precipitate form with propofol in my practice. Do you mean in that it is a opaque white emulsion, precipitation would be hard to visualize?

Hello Everyone! I had a quick question about this article I came across regarding LR compatibility. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8326865/pdf/10.1177_0018578719888913.pdf It specifically states the finding that propofol precipitates out with LR and the solutions are not compatible. In my ICU, I have seen and run propofol and LR together, pushed Prop with LR during intubation codes, and I feel that most OR fluids include NS or LR and propofol is commonly infused as an induction agent with LR. I guess my question is has anyone ever noticed a precipitate/incompatibility in regards to LR and propofol? I feel that if this really was an issue it would be more well known? Thank you to anyone for your time

Hello Everyone! I recently had a question come up and I was not sure how to answer it. The question was if IV incompatible meds could ever me inadvertently mixed together if two infusions ran through two different PIVs but the PIVs were in the same vein just one lower down and one higher up on the vein. I have never had an issue or come across this and I normally infuse IV incompatible meds through the same arm as long as they have their own site and are not y-sited together. Has anyone ever come across this issue? I would think the dilution and blood flow rate would prevent mixing of the solutions to a degree that would prevent chemical/physical interaction. But also if you were concerned that the IV infusions were going through the same vein you could run the faster infusion higher or closer to the heart or just start another line on the other arm if possible. Thank you for any input and your time!

Hey Everyone! I am fairly new to CRRT and had an issue come up one night. I was having problems with my access pressure being extremely negative. I was troubleshooting and ultimately my Vas Cath location was just not going to work anymore. I tried to return the blood before my filter clotted off and I was able to. However, when I went to do my I & Os for that hour the actual CRRT fluid removed was a negative number (-127). I understand that because I was having so much trouble with my access I was not able to pull anything so this accounts for delivery of fluid. But I am just confused by how I delivered so much? Also what was the fluid being delivered? Was it just the NS from the filter when I delivered the blood? Or is this the replacement fluid? I guess I am confused how and where this number came from. Thank you to anyone who has any help!

hey everyone! I just had a question about manifolds. I was told by a senior RN that it doesn't matter the order you connect drips to manifolds. For example, the rates of the separate drips don't matter as far as connecting the drip going at the fastest rate closest to the patient. I think this is because the carrier fluid I had going was going at 200cc/hr anyway so it probably did not matter the rates of the drips connecting into the manifold. However, from my experience and from all the research I have seen normally the added flow of rates do affect one another even with manifolds. However, manifolds are beneficial because they provide essentially for your drips to reach the patient faster instead of y-siting a bunch of drips together.

thank you for your response. I have not been provided rational, and I just have never seen a patient with a trach with an OG and I had assumed it is a contraindication. I just spoke to my nurse educator though and he said OG tubes and trachs are not contraindicated, but I think however a lot of our trach patient are relatively conscious and oftentimes because of that reason we do not place OGTs.

This is probably a dumb question, but I have personally never fully understood why we cannot placed OGs in a patient with a tracheostomy. The trach is placed under the vocal chords in the trachea and the OG is in the esophagus. It is something I know we do not do, but I cannot explain exactly why. I know some patients can eat even with a trach. Appreciate any feedback or help! Thank!

I have a question regarding IVPB medications. 1) Example: Can you give IVF at 75cc/hr and Zosyn IVPB at 25cc/hr as concomitant infusions or would this cause the Zosyn to be infused at a faster rate? 2) At what rate do you flush with IVF/primary infusion after secondary or IVPB infusion is done? Do you use the same rate as the secondary infusion in order to clear whatever volume is left in line? For example Zosyn is going at 25cc/hr and the priming volume on our tubing is about 13cc. Would you program the IVF to infuse at 25cc/ hr for approximately 13 cc to clear line? Thank you for any time.

If you have an arterial line and IV gtts going do you need to stop them to draw blood from arterial line? Will the arterial line blood be contaminated if you draw the sample while the IV drips are running? Thank you.