Published Jul 23, 2009
Okay-I'm in a new hospital that is 'isolated and diffrerent'. Here goes...Does anyone out there use low absorption tubing for diprivan? Also, the pharmacy supplies us with a four way stopcock that "must be used" with every tubing change (which, BTW, they only do every 24hrs:madface:). There is nothing in this facilities policy on using this tubing, and even the supervisors do not know the reason for the stopcocks-the stopcocks are from B. Braun and specifically say for use with diprivan...its a STOPCOCK none the less... no different that any other stopcock in this place:uhoh3: .As for the tubing issue...I asked one nurse why she's using this...she said it was easier to vent the tubing to prime it (again:uhoh3:). I asked her if she thinks that gets expensive when changing the tubing every 12 hrs (that flew over her head)...she said "change the tubing every 12 hrs????" Enough said! I use the vent that comes on every tubing set but what the hell do I know...I didn't work HERE for the last 100 years-which is how old the policies are:lol2:. I try to do a little spoon-feeding education without seeming like a person trashing all they've been doing, but no one seems interestede in doing things that are based on current evidence--only what they have always done. thanks for listening:yeah:
dorimar, BSN, RN
It is very difficult when you practice by "standards of practice" and evidence-based practice, and those who do not treaty you like you are the one practicing incorrectly. I worked in a rural hospital once for a year and it was a nightmare. Not because it was rural, but because the practice was not up to par and when you did it correctly, they rolled their eyes and talked down to you... Crazy.
Example: a new nurse was asking me about reading a wedge pressure and I was explaining how to measure on end-expiration. An "exprerienced nurse" butted in and snidely stated, "We don't do it that way here, we just measure the mean". When I asked her why, she stated, "because that's the way Dr. so-and-so wants it" . I just said, "ok...."
I've never heard of using a stopcock on diprivan tubing. Moving a stopcock around, especially with a substance like diprivan, *especially when the tubing is only changed every 24 hrs* just sounds like a good way for the patient to develop line sepsis.
PICNICRN, BSN, RN
I wonder... do they change thier lipids Q24 also?? I think the standard is change Q12 and I cannot say that I have ever hear of the need for a stopcock kor special tubing for Propofol either.:uhoh21:
No stopcock but our policy is to change tubing q 12. We run D5 as a backup with the diprivan, diprivan placed on a seperate pump, placed at the y port. No stopcock would be needed as we can simply titrate the diprivan on it's own pump. Could that be a reason for the stopcock in your situation? Are you running the solutions concurrently?
We do use a different tubing with our Diprivan that is meant for glass bottles and makes it easier to vent, but I've never heard of the stopcock. I'd be interested in the reasoning behind that. Also, we change tubing every 12 hours.
criticalHP, MSN, RN
Frankly, Id be afraid to look at what other nurses here do with drips. I've seen things that make me burn with rage such as running IVPB abx in a line with dopamine! And then they wonder why they chase labile BP's all day and night! But just try to tell em
Personally I run all drips on it's own pump with a carrier behind it-unless it's compatible-diprivan alone. I change my tubing on lipid agents q12h-the package insert even says that on diprivan. The policy here is to change lipid tubing every 12h but I honestly don't think it clicks that diprivan is a lipid:confused: . Its just not given that often--I mean I came on shift and the damn thing was running at 85mcg/min and it had been like that for an entire 12h shift! Even the doc agrued with me when I said I wanted a concurrent drug (ativan or versed) to get the propofol down because of poss liver damage and spiking lipid profiles--this was an MI pt after all!!! I've seen propofol infusion syndrome and it is scary! As for the stopcock and the 'special' tubing...I'll claim ignorance in the policy (which doesn't exist anyway). I figure its better to get forgiveness than seek permission. And I'm the one with the CCRN--for a 50 mile radius...but most nurses here don't even know what that is so I'm the ignorant one for not knowning their 1960s ways. I can't wait to be done here: I just hope no one in my family needs care here in the stone age.
Yes, some pump manufacturers require special tubing for glass bottles. We use alaris here so the tubing have a vent at the spike. I believe horizon NXT may use special tubing for glass but its been a while since I used that...about 8 yrs. Anyone know? And if you do use a horizon NXT does diprivan require a stopcock? My thinking is that maybe it has something to do with the pump system??? But, you would think our own pharmacy would know we use alaris, which has a vented tubing:confused:.
Like I said...this place is so isolated. It's not the end of the Earth but I can definetly see it from here:chuckle
The previous hospital I worked at just used Baxter tubing (Non-vented) and added the vent to it, no stopcock, changed it q 12. The current one uses Alaris, so tubing (general tubing) is already ventable and yes we use the stopcock and change q 12. I was actually looking up WHY when i stumbled on this thread! LOL. Even before we converted to Alaris and used Baxter pumps we used the stopcock. I will keep searching, because the ones we use are marketed BY Propofol, and blue and white... As far as drip "chasers" I have never used that. Antibiotics are never run with gtts, but we use "micromedex" for compatibility info, we will Have prop, Fent and Ativan together if need be, Or Fent Ativan/versed and Levo. We run insulin gtts with hydrocortisone, Protonix gtt with Bicarb gtts, Those are common mixes we use, otherwise I have to look it up. I want to know Why hasnt compatibilty of Octreotide and Protonix been tested?!? It sucks having 9 gtts and a measly triple lumen and hoping compatibilty allows you to have a port for antibiotics!
Thanks for the reply. Its funny, and by that I mean suspicious, that the stopcocks are manufactured by the makers of propofol. We use alaris pumps too but that is irrelevent with regard to using the stopcock for diprivan in bedside practice. I wonder if the stopcock is something that is used by anesthesia? Any CRNA's care to reply?
As far as concurrent drips go, sometimes you have no choice, such as open heart pts with a cordis. We would run NTG, dopa, levo, and amacar, plus insulin,, sometimes others. If sedation was required we had a peripheral (hopefully working) so we didn't "push" the vasoactives, but occasionally propofol would find its way on the cordis line up when no other choice presented itself, and I would try to titrate as little as possible to prevent the vasoactive responses from other drips. IVBP were absolutely never run through the cordis with any drip, and for that matter any other type of central/peripheral line with a drip. No drip--you're good. The CVP port is a good option for intermittent infusions too.
In pts needing multiple sedatives and analgesics we would commonly combine versed, fentanyl, and/or ativan at one site. Not too sure on the steroid and insulin combo...seems like they would crystalize --I have not looked this up mind you and I'm sure you have, so if lexicomp or whatever reference you are using says its compatible then, hey :)
Do you have an resident ICU pharmacist? They can be very valuable with these issues...a good plug to get your administrations to hire them. Nurses have a lot to do and having one of these smarties on staff can save a lot of time--maybe even a life :redbeathe
Thanks again for your reply!!
The stopcocks may look the same but they are made of a different material than standard ones. Lipids crack stopcocks made of polycarbonate (of which virtually all regular stopcocks are made). This has been studied using regular 10% lipids and Propofol in a 10% lipid emulsion. The stopcocks cracked with both so it's clearly the lipids that are the problem. The stopcocks that are packaged with the Propofol aren't required for infusion but if you need to use a stopcock then that's the one you have to use. It should be noted that if you use more than one stopcock (manifold setup) then the Propofol stopcock must be closest to the patient to avoid cracks in the other ones. As for the remainder of your issues (tubing changes) I'd like to add an educated EEEEEEWWWWW! Has nobody there heard of Malasezzia Furfur?!!!!!
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