Simple IV Questions

[MAL, RN]

You have only one IV access. (For whatever reason).

You have two IV medications to give. They are compatible.

Lets say one is Insulin at 8ml/hr, the other NS wide open.

1--If you put the insulin gtt on a pump at 8ml/hr and the NS via gravity, can you piggy back the insulin into the NS tubing, or is there a risk that the insulin could back up into the saline? Either during the tandem infusion, or when the NS is finished?

Or 2-- what if you had two IV solutions- neither need pumps. Say one is NS, the other an ABX that can be given over roughly 20-40 mins. If you dont want to stop your fluids, can they both be hung via gravity and infusing in tandem? Thanks..

I worry that with such a small amount infusing, such as in the case of insulin, that some may back up and not reach the patient.

3-- when you hang a medication that infuses slowly, are there any tricks to get it through the connection tubing without bolusing it? (or a safe way to bolus it) The connection tubing between the cannula and IV tubing has been flushed with a saline flish, so saline is sitting in the connection tubing. Im thinking in the case of Nitro at 3ml/hr, where it would literally take an hour to flush out the saline.

4-If a drip such as insulin or nitro is finished and you need to flush the line for a new medication, do you aspirate from the connection tubing to prevent bolusing? Or in a similar scenerio, if you needed to give a push medication while a patient is recieving a drip such as insulin or nitro (in other words, a carefully titrated drip).

Im sure this is addressed on this website already SOMEWHERE, so sorry in advance. So far, Ive just been starting a second IV site. But in some of these dialysis patients, its impossible.

[Music in My Heart]

Agreed. Im not so much questioning what insulin can be piggy backed with, but the pump piggybacked into a gravity drip.

I hear you regarding "sometimes you don't have much choice" and sometimes the veins just ain't there (you know the ones... the long-time IV drug users, the LOLs with the spider veins that barely take a 24, the 99 YO whose veins blow just by looking at 'em cross-eyed, the morbidly obese person whose ACs are buried beneath 3-4 cm of fat).

If you really have no choice - and the doc concurs on same - be absolutely certain that your gravity line has a *functioning* check valve to prevent back flow (to check, connect a flush to a distal port and then kink tubing distally to that... if you can flush then your check valve isn't working). Keep a watchful eye on the drip chamber to note the steady, even dripping, the lack of bubbles going into the bag, and that the level in the drip chamber is not increasing...

and then work on getting another line ASAP by means of ultrasound, PICC, subclavian, EJ, etc.

[jwilk1046]

I agree and this is how I run Ns and insulin. Two pumps, Y site close to the patient

[akulahawkRN, ADN, RN, EMT-P]

If all I have is one IV access and I must infuse NS and insulin through that one single line, I would want to have either a Y extension set or a T extension set on that catheter, preferably a T set. Both the NS and insulin will be set up as primary lines, both would be on a pump. The NS line would be connected to the long tail of the T set and the insulin line would be connected basically at the hub. This minimizes the volume of insulin between the port and the tip of the catheter should the NS line stop infusing and therefore also minimizes the bolus effect once the NS infusion is restarted. If a Y extension set is all I have, then I'll deal with it, but I'd prefer a T extension set. If I can create a T extension somehow with a 3-way manifold, I'll put that as close to the hub as I can and attach the extension on to that. Frankly I'm actually not that worried about a small 0.4 unit bolus of insulin or short duration (few minutes) effective stoppage of that infusion as it won't have much effect either way (assuming 1u/mL insulin drip) however I might be very wary about vasoactive drips so I'd want to minimize any bolus effect or stoppage effect that occurs when changing rates on a carrier drip (like NS). Those should go on their own dedicated lines if possible where there's NOTHING else on that line.

I'm also an ED RN so if that's what I have, then that's what I'll work with... while I try to establish more access because it's much safer when dealing with multiple drips.