Setting up Manifold using 3 way stop cocks

[Walle2014]

Hi everyone,

I am a new grad hired into PICU/critical care. Today my preceptor and I were discussing how to set up a manifold for central lines using three way stop cocks. I understand the rationale behind using this for running several medications in one lumen, but I was lost as we went over the actual mechanics of how to set it up. I felt like when I put one together and got it all primed that there was a lot of air introduced into it that I could not get out. Am I missing something? What is your guys methods for setting up manifolds in this fashion?

We also talked about "double pumping" medications such as epinepherine. It was explained that you have an extra port so as you turn one off you can immediately turn one on so the patient doesn't experience a lag in med administration, but how do you achieve this when the actual manifold needs to be replaced on the lumen carrying this medication?

Thank you all very much!

[marienm, RN, CCRN]

I don't know what your preceptor showed you, but I typically prime each stopcock with a NS flush syringe...attach syringe, prime the "straight" portion (with the lever OFF to the side port) then prime the side port (lever OFF to the straight port), then attach it directly to the patient's IV and hook up med lines. You could do the same if you were setting up a brand new line...attach stopcock(s) to the tubing before you prime it and then systematically prime each port. Redcap (or whatever your policy is) any port you won't be using right away.

As to double pumping...I don't do this for adults. If I have all my stuff prepared (line already primed with new stopcock on it, already made sure that the tubing is loosened, etc...) I genuinely think I can change out a line and restart it within 10-15 seconds. For most adults, that won't drop their BP too much. But if it's your practice for kids to have the redundant pump set up and ready, then just make sure it's really *ready*...line all primed, any new hardware already attached, concentration and dose programmed correctly, old line loosened...before you stop the old channel and swap them. You probably swap *all* the critical lines at the same time as well as the clave if the goal is replacing the manifold, right? It's all about being organized ahead of time and maybe asking for an extra set of hands/eyes when it comes time to swap (and you should be double-checking all critical infusions anyway!)