tridil and heparin together?

2ndCareerRN · Mar 15, 2005

If I am hanging tridil and heparin then I am probably dealing with an AMI so I start 2-3 lines. I used to run NS and tridil together and then use another access point for the heparin if we use it.

Now that Lovenox is replacing heparin, that is taken out of the picture. I still start 3 lines in cases where we use tPA. If not, I will start 2 lines, heplock one, and run the NS and tridil in the other. I hook the tridil as close to the pt as I can.

Because we are remote, if we are dealing with an acute MI we will use lovenox, tridil and tPA.

For ACS we will do lovenox, tridil, plavix, and integrilin and hope the helicopter can fly in to get the person to the cath lab . If not we have a 40 minute ground transport to the nearest airport the fixed wing can use.

bob

hollyster · Mar 15, 2005

Heparin and tridil are compatible. We have no policy on how they can be run so it is up to the nurse how they want to run it.

Hopefully, two large gauge IVs are in place in he AC or high on the arm(or in a perfect world some nice Dr. put in a triple lumen C-line.) Everything should be in place in case pt starts having arrythmias or crashes. If the pt is stable I would piggyback the heparin into the NS low port through a pump and run the tridil in the other arm. I know this may sound ridiculous but make sure that you have the right concentration of heparin(not A-line flush) the bags look identical so it would be easy to hang the flush instead of the full strength.

I the pt is showing ANY sign of instability I would piggyback the heparin into the nitro so that there would be one free line for ACLS drugs.

rjflyn, ASN, RN · Mar 15, 2005

Personally the two drugs are compatible so why not. If I were the patient I would have a hard time with you starting a 3rd IV on me just because you dont want to run those two meds together to keep the second site free for "just in case" Now if it's a facitlity policy well then theres not much one can do about it. But then thats why they make dual port extensions to connect to the IV cath. Twin IV catheters are nice as well. If I have access to those catheters and Its likely a patient is going to get more than one drip I start the line with one and I have 2 sites.

Another question to go with this thread- How many nurses automatically go start that second line in the oposite arm?

rj

hollyster · Mar 16, 2005

Personally the two drugs are compatible so why not. If I were the patient I would have a hard time with you starting a 3rd IV on me just because you dont want to run those two meds together to keep the second site free for "just in case" Now if it's a facitlity policy well then theres not much one can do about it. But then thats why they make dual port extensions to connect to the IV cath. Twin IV catheters are nice as well. If I have access to those catheters and Its likely a patient is going to get more than one drip I start the line with one and I have 2 sites.
Another question to go with this thread- How many nurses automatically go start that second line in the oposite arm?
rj

In our unit we put two IVs in whenever anyone is on a drip. If you lose one site there is always another one ready to go. Heparin is hard on the veins and it is hard to get IV access after a pt codes. I would not put in a third IV site, if the pt needed three(pt would have to be in very bad shape) I would request a C-line placement.

I usually put the second line in opposite arm unless contraindicated.

Holly

t.sandoval · Mar 16, 2005

I work at an ER in Ft. Smith Arkansas. Our policy states we hang heparin, and nitro on an onmi pump with NS. Protocal is a 5,000 unit bolus of heparin with a drip of 1,000 units /hr The Nitro is at 5mcg/min titrated as needed.

t.sandoval

I would like to know how others hang their tridil and heparin IV when ordered on the same patient. Does your facility allow them to be infused via the same site? And which do you connect closest to the patient? Also, if you hang them to separate IV sites, do you run NSS with the tridil and which of those do you connect closest to the patient? It seems every time we do it here at my ER, each nurse does it differently.
Thanks
Dawn

shadowflightnurse · Mar 22, 2005

I personally like to hang Heparin and Nitro together with NS as a main line. The nitro at the port closest to the patient. I also work as a flight nurse.One thing that drives me crazy is when we pick-up an AMI who has 3 IV sites...#1-NS, #2-Heparin, #3-Nitro :rotfl: !!!

allele, LPN · Mar 22, 2005

I usually run them in the same line, both connected to a Y-port, so there isn't one closer than the other. If there isn't already a second line in, I call IV therapy (Gosh, I love them!) to start a second line. :)

2ndCareerRN · Mar 22, 2005

One thing that drives me crazy is when we pick-up an AMI who has 3 IV sites...#1-NS, #2-Heparin, #3-Nitro !!!

We will do 2 sites for AMI without tPA, one for the NS/Tridil and one spare.

The only time we do 3 IV's is if we are going to tPA the patient. Some hospitals I have sent AMI's with tPA going request the third line so they don't have to start one after the tPA has been started in case the other two go bad.

With ACS, the pt will get two lines. One for NS/NTG/Integrelin, and one spare in case of lasix or other incompatable drug.

Heparin infusion is not even used where I am at. We use SQ lovenox.

bob

Zachary2011 · Mar 22, 2005

Hep and tridil are compatible, no reason to run seperatly, this also decreases pt. safety issues with less lines, allows pt a little more freedom of movement. I always run NS with any drip that is infusing under 10 cc hr, so with Tridil that many times needs titrated I always use NS to KVO. As for as which is my primary (line closest to pt.), it shouldnt make a difference, if running via infusion pump the gtt is going into the pt. at whatever rate you set, be it the primary, using a y'd heplock, or just tied into whatever is infusing at the time. Many times Ill hang a tridil gtt for chest pain and then come along later and hang NS as my piggyback and infuse them together. Sometimes a staff member will say thats not correct, but again the meds are being infused at whatever rate is set, changing from primary to secondary has no effect on rate. Also at my ER, we continue to use Hep. and Integrillin, Reopro, etc., These are all used to keep blood thin, or keep platelets from attacking say a recently placed RCA Stent. But keep in my these all act on different platelet factors, they do a similar job but they work on different factors. Many times you need Heparin and Integrillin or Heprin and Reopro, mainly post intervention from the cath lab. As for as Lovenox, we use it also but if someones having an MI, or at high risk of, start a Heprin gtt, dont give a subcu lovenox shot. Heprin not only works quicker, but also stops working quicker so that the pt. can easily be taken to Cath Lab or Open Heart without increased risk of bleeding.

shadowflightnurse · Mar 22, 2005

I run the NTG at the lowest port for two reasons.

1) When starting a NTG drip (say 3cc/hr-10mcg/min with 50mg/250cc conc), if you use the highest port it will take longer for any of the NTG to reach the pt.

2) If something goes wrong (like the pt's pressure dumps) and you have to give a bolus, you would be infusing whatever NTG was left in the tubing..from the highest port down to the pt. (assuming you had NS up and not just the NTG. It may not seem like much NTG, but if there is 2-3cc in the tube that would be roughly equal to a SL NTG.

I'm not saying my way is the the only way, but just the way I do it.

TinyNurse, RN · Mar 28, 2005

at vandy er, i run nitro and heparin both on pumps through the same site. nitro in the closest port with .9 as my back up infusion.

you need AT LEAST 2 lines in AMI so once I start them I leave the second for whatever comes next.............. whether retavase or sending them to cath lab.