question about triple lumen

Sun0408, ASN, RN · Mar 10, 2012

The rate would be what ever the MD wrote for, sorry but that is not a standard number. If could be 20 cc/hr to say 500cc/hr depending on what the pt needs.

susto · Mar 10, 2012

The rate would be what ever the MD wrote for, sorry but that is not a standard number. If could be 20 cc/hr to say 500cc/hr depending on what the pt needs.

thank you! i actually edited my ques b/c i just found the med sheet that showed rates. but im still confused as to why the pt had a triple lumen and not a reg iv? my pt was recently trx out of icu, so maybe b/c she was critical.

Double-Helix, BSN, RN · Mar 10, 2012

A triple lumen catheter is a type of central line. This means that it enters into a larger vein with more blood flow. This allows us to give higher volumes of medications as well as medications that may be damaging to blood vessels. A central line can be left in for longer than a peripheral IV. The catheter is longer and larger, which makes it more durable. Triple lumen refers to the number of ports, or openings on the line. A triple lumen as three separate tubes that open at different intervals along the catheter. This allows you to give medications that are not compatible through the same line at the same time. With a regular IV you can only give medications that are compatible at one time.

In contrast, a peripheral IV enters a small vein on the periphery of the vascular system. The catheter of the PIV is much shorter. Medications given through a peripheral IV need to run at a slower rate. There are also medication that absolutely cannot be given peripherally because they can be harmful to the veins. Look up pictures of medication extravasation injury and you can see what damage can be done if medication given through a PIV infiltrates into the skin. In the case of some medication, such as bicarbonate and calcium, administering through a PIV can burn the vein to the point where the patient will need amputation. Not good. PIV's also do not last as long. Since they sit so close to the surface of the skin, they tend to fall out, get kinked, and clot. So they need to be replaced frequently. This isn't good for patients who need long term medications.

A central line is inserted for several reasons:

1. The patient has no adequate peripheral access. Some patients, especially those who have been in the hospital multiple times or who have compromised circulation (due to a mastectomy, amputation, fistula, etc) have very few or no sites that a peripheral IV can be inserted. If that's the case then the patient will likely get a central line.

2. The patient needs long-term medication administration. The most common situation for this is long-term antibiotic administration, such as the patient that needs a 6 week course of antibiotics to treat meningitis. There are other medical conditions that may need long term IV medication as well.

3. The patient needs medications that are damaging to the veins. Some examples are: TPN, high concentration electrolytes, high volumes of dextrose, and chemotherapy. These medications can really damage the peripheral veins if given through a regular IV, so they need to go through a central line.

4. The patient is on multiple medications that aren't compatible. A good example is TPN, total parenteral nutrition. TPN can only be run with a select few medications. TPN runs for about 20 hours per day. So if your patient is on TPN they need multiple lumens so that they can get their other medications. If they are on a lot of different IV medications, such as multiple antibiotics or multiple vaso-active medications they will need multiple lumens as well.

I don't know exactly why your patient had the triple lumen. Since you said she was recently transferred out of ICU, I'm guessing it was because she needed high volumes of multiple medications that may have been damaging to peripheral veins. Once they have the central line, they aren't going to take it out until the patient is ready for discharge- even if they only need a few antibiotics and IV fluid. That's because a central line is actually much better access then a peripheral. They don't have as many complications and don't need to be changed as frequently. They are especially helpful in the elderly who have poor peripheral veins. Keep in mind, though, that a central line poses a much larger risk of infection then a PIV, so aseptic technique is a must at all times.

nurseprnRN, BSN, RN · Mar 10, 2012

one more thing: long lines in groins are more susceptible to infection than the same lines in the chest (like subclavian), so please make sure every shift knows to monitor it, be extra-vigilant about keeping the dressing intact, and do meticulous site care.

ckh23, BSN, RN · Mar 11, 2012

If they had a triple lumen in the groin I'm thinking they had extremely poor access or some type of contraindication for an IJ or SC site. In my experience groin lines are usually put in emergently in the ER or as temporary access until the patient can get something else like a PICC. The groin is the least favorable site due to high risk of infection, but sometimes there is no alternative. In my facility the policy is that all groin lines can only stay in for 24 hours.

Yes you can use them just like a peripheral IV's, but one advantage is that you can infuse multiple things because of the 3 lumens. So you can be infusing IVF, TPN, Pressors, etc at the same time.

0402 · Mar 11, 2012

The pt population I see them in the most is my ESRD pts. It allows us to give IV meds, but also to draw labs on pts that we most likely would not be able to get any labs from (yes, they get them on HD, but when needed on the other days, it's great to have the access). They are definitely high risk for infection and need to be monitored meticulously. They are generally the least preferred location for central access, but if there is no where else to go, at that time, it will do the job.

Is the question about location or about the fact that they have 3 lumens vs 1 or 2?