Running cardizem drip?!

[johndough]

I am just not sure about running this medication.

So I have one pump with 2 brains/attachments and one IV access. On brain A, the NS is running and directly attached to the patient's IV access. I needed to hang cardizem 5mg. I was going to attach it as a secondary line to the NS but was told that was wrong.

So, what I was told was that to use a primary line and hook it up on Brain B and merge the cardizem line to the NS line on the port nearest to the patient.

I was just wondering if this was a correct way of running cardizem? I mean I would have been happier to just run the cardizem on a whole different IV access rather than merging it with the NS.

Thoughts?

[tcvnurse, BSN, RN]

Oh my god if you are thinking about running cardizem gtt as a secondary then you shouldn't be running it. Doesn't your unit have protocol or say a charge nurse who can help you out with this in the moment?

[EllaBella1, BSN]

As a general rule, NEVER hang any titratable drip as a piggyback/secondary. You always run the risk of the bag running dry and flipping over to the primary if you forget to run it concurrent for any reason, among other issues. I tend to not even y-site any titratable drips into one access point because there is always that risk of the concentration being altered. I definitely would have run it alone into it's own IV lumen/site.

[Here.I.Stand, BSN, RN]

So, what I was told was that to use a primary line and hook it up on Brain B and merge the cardizem line to the NS line on the port nearest to the patient.

I've done that when all 8 of my access ports are in use. But since your pt only has one IV, I'd start by starting a second IV. It's good to have a backup when continuous drips are running anyway; what if the single IV infiltrates? The pt will be without the drug until another is started...and sometimes that takes a while in our imperfect world.

[tnbutterfly - Mary, BSN]

Moved to Patient Medications

[kalycat, BSN, RN]

So yeah, never ever run a high alert Med as a piggyback. (Ask me about the time that a panic stricken nurse on another floor had their "B" line fail on a plum pump due to some sort of tubing issue and the patient got a 500ml bolus of a high alert medication in 30 minutes)

A second IV is ideal, but if you can't get one, then y-sited at the lumen closest to the patient is the safest method. On our unit titratable vasoactive drips need a stable access point, preferably a picc or central line. If that's not possible, you can't go wrong with two large bore IVs.

[~Mi Vida Loca~RN, ASN, RN]

I always get 2 lines when starting any kind of continuous medication or if they are going to be on multiple abx. and getting admitted. Only time I don't start a second line for abx is if it's a one time deal for us and then we are sending them home. But Nitro, Cardizem, Insulin, multiple or continuous abx, etc. or person is just really sick. I always get two lines and if it's emergent to start the medication right then I will start it while I get their second line established, but that is rarely an issue because we are doing 2 lines right away for an emergent patient anyway or we give a bolus of the med and buys us 15 or so minutes to start my second line.

[AJJKRN]

Always look at your facility's protocols. Any high alert drug, including cardizem, at my facility requires the med to be on its own pump and clearly labeled...what the patient has for IV access and compatibility determine whether the med needs its own IV access line or if it can be Y'd in. FWIW, your facility may even spell out which med line is to be attached to the patient first when Y'ing in.