Stopcocks and Manifolds

[mhwh22]

I am a new grad nurse working on a hem/onc floor and we have our lines made by pharmacy. The manifolds typically consist of 6 or so stopcocks lined together with caps on each and one syringe med port. We typically have fluids running on the far left and a chemo drug such as mesna running on the far right.

I am still struggling to figure out which way to turn the stopcocks! For example: I scrub on a syringe of zofran (i work in pediatrics so most meds are IV) on the fluid line through the tubing coming off one of the stopcock caps running through a separate lumen than the chemo so i scrub that on and run it and they told me to turn the "off" side of the stopcock switch all the way towards the back.

This still confuses me. Is there fluid running through the middle? I don't see how these aren't mixing? Shouldn't the "off" be facing the right?

My preceptor is not a good teacher and I can't ask her a single question without her making me feel like an idiot. It is my second week on the floor with her and I am expected to know everything though I'm seeing manifolds, stopcocks, and central lines for the first time!

I know this is probably a dumb question but does anyone have any good resources for this sort of med administration or instructional videos?

[chare]

This still confuses me. Is there fluid running through the middle?

Yes, there is.

I don't see how these aren't mixing?

Using a stopcock manifold allows multiple compatible infusions through a single access point. As these solutions will mix in the manifold you need to ensure that everything that will be infusing simultaneously is compatible.

Shouldn't the "off" be facing the right?

When you turn a stopcock "off" all infusions proximal (IV bag side) that port no longer pass to the patient. For example, if you were to turn stopcock 3 off the patient will not receive the maintenance IV fluid, as well as any infusions running into stopcock 1 or 2.

no longer allows any infusion or medicationstops the flow of fluid from that point back to the As the maintenance IV fluid is entering from the left of the manifold turning the stopcock "off" to the right will not allow any fluid or medication to reach the patient from that point

The manifolds typically consist of 6 or so stopcocks lined together with caps on each and one syringe med port. We typically have fluids running on the far left and a chemo drug such as mesna running on the far right.

Out of curiosity, why do you use this many stopcocks in your manifold? This seems to me a lot of weight on the end of the line, as well as a lot of dead space.

I know this is probably a dumb question but does anyone have any good resources for this sort of med administration or instructional videos?

Not a dumb question at all as working with multiple stopcocks can be confusing for an experienced nurse.

[mhwh22]

thank you for your response! it is helpful and I am better when I am visualizing the actual manifold and lines but don't ever want to take too much time or ask questions because my preceptor acts like it should be simple.

I really don't know why we use so many, we are the only floor that does this and pharmacy makes them and sends them up to us, probably because these chemo protocols call for sooo many meds back to back or at the same time...?

usually there are maintenance fluids, at least one syringe med, a secondary flush bag, and then 2 or 3 for other chemo drugs and/or add on syringe pumps to flush meds through when they are done which we y-in under the pump after it runs dry to get everything through the line to the patient.

it's very confusing and when you don't feel like you can ask a question without someone looking at you like you are uneducated and incompetent it's really hard to learn.

just a struggling newbie, but I am sure it will get better with time...