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!

[chare]

Assemble all 3-way stopcocks to be used. Turn the stopcocks off to the distal (patient) side. Prime the clave prior to attaching to the stopcock. Attach the stopcock to the proximal (IV line) end and flush through the side port. Attach the clave to the side port and turn that stopcock off to the proximal end then flush through the side port of the next stopcock. Attach clave to the next stopcock airport and repeat. When flushing any stopcock hold the manifold so that the stopcock is above the flush.

As for “double pumping.” If you're just changing the bag or syringe, most patients tolerate the brief interruption required to change the syringe or reprogram the pump. As for changing the lines and stopcocks. If the patient is that labile, I set up all infusions on another set of pumps. When the infusions have run long enough that they have all reached the distal end of the stopcocks I switch out the stopcocks and move the previous pumps out of the room.

Best wishes.