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Triple Lumen Ports

Nurses   (156,989 Views | 21 Replies)
by Dawson Dawson (New) New

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Got my chops busted yesterday in clinicals for not knowing which port is used for what in a triple lumen central line (which port for IV fluids, which for TPN, etc.) and can't find info in my textbook, class notes, or online. Can anyone help me out? Thanks.

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RNPATL is a MSN, RN and specializes in Nursing Education and Critical Care..

Quote
Originally posted by Dawson

Got my chops busted yesterday in clinicals for not knowing which port is used for what in a triple lumen central line (which port for IV fluids, which for TPN, etc.) and can't find info in my textbook, class notes, or online. Can anyone help me out? Thanks.

If I remember correctly, the triple lumen has a proximal, medial and distal port. The proximal is the brown cap and is used for blood draws, the distal (white cap) is the port used for infusions like TPN and the medial port is used for routine fluids and IV meds on a pump. Of course, once you get into practice, nurses use all of the ports sometimes without regard for their intended use.

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Thank you very much. I will definitely remember!

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gwenith is a BSN, RN and specializes in ICU.

Be careful not all lumens are marked with the same colours!!!! Ours is brown - distal and is used for monitoring

The distal is always for monitoring and for blood administration as it is the largest lumen (usually) In the absence of monitoring it is used for TPN.

TPN should never be given through the proximal port as it is the most likely post to be displaced into the tissues and TPN, due to the high dextorse content will "burn" if it tissues.

Inotropes should be placed on a lumen by themselves and usually a medial lumen, again because many of the inotropes (most actually) will burn if tissued. Inotropes are NEVER placed on the same lumen as the monitoring as they may be accidentally "flushed"

Hope this helps.

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I'm confused too. At least I feel a little better about getting my chops busted!

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Last patient I had with a triple lumen Hickman was on 24 h. a day Pen G for an infection. He was very heavily anticoagulated for severe CAD, so we could not use a peripheral IV on him. (The Hickman insertion site bled so profusely that he wound up in the hospital for a few days! Never SEEN such a bloody mess!) We rotated the IV pump from one port to another every time we did the tubing change (every 72 hours). The idea was that the rotation would help keep the ports patent.

Edited to add: I believe the size of the lumen is marked on the catheter, just below the cap. So, never mind the cap colour, look for the gague! The largest will be for drawing blood or giving TPN.

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I agree , be careful. Our Brown port was to be saved for Hyperal.

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ok...a port is a port-a-cath, completly under the skin and is accessed with a needle...it's a single lumen central line. I think you are talking about broviacs here...

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Maybe I can help ya out a little heah, from up heah in Bahston.

First concept is that with regards to the position of the ports, the normal idea of distal and proximal is reversed. Like, normally, the fingers are distal to the elbow, right? Further away from the center of the body?

Not so with multi-lumen lines. The ports are described in relation to the insertion site - where the line enters the patient. So the port that opens up at the tippy end of the line - which is the brown-ended one on an Arrow multilumen - that's the distal port. The blue one is medial, the white one is proximal - closest to the site of insertion.

Next: you wanna use the brown port for your CVP transducer, on account of it's the largest lumen, also it's looking straight down into the RA. Make sense? We use them for intermittent med infusions like antibiotics, etc., never for pressor/vasoactive drips.

Blue and white ports can be used at your preference. I never heard of TPN "burning" anyones vasculature in relation the port chosen - I been hanging TPN for a long time, too. Doesn't ring no bell.

An important point: don't run anything into a central line lumen without checking that there's a good, visible blood return. Suppose you turned your patient over and the line took a yank, got pulled out a couple of inches. If you were infusing pressors through the proximal port - perfectly ok in a properly situated line - and those pressors now began infusing into the tissue on account of the port was pulled back out of the vessel - that would be a bad thing. As a stopgap you could switch the pressor infusion to the distal port, get your x-ray, and think about getting the line replaced.

Luck dude. Bust their chops back!

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gwenith is a BSN, RN and specializes in ICU.

Hi ya Mark - The one about teh TPN I got from one of the "educational videos" that was doing the rounds some years back but it made sense because the reason why we do not infuse TPN peripherally is that it will cause a 3rd degree burn if it extravasates - my early years in ICU (you know when there were dinosaurs around) I actully saw exravasation of 50% dextrose on a peripheral site - nasty nasty burn!!!!

BTW I will be using one of your FAQ'a as a handout of a talk - I looked it over and decided I could not do better!!!

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Zee_RN has 17 years experience as a BSN, RN and specializes in Hospice, Critical Care.

I was always taught distal for blood draws, medial for TPN and proximal for IV infusions. But I don't think that is a "hard and fast" nursing rule; the safest answer would be "CHECK COMPANY POLICY." I have seen all three ports used for all three stated uses. If you do have CVP readings, you must have your transducer connected to the distal port.

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