Use of backup saline infusions for medication infusions in ICU

offlabel · Jul 4, 2016

Yes...a normal saline "carrier" just facilitates a more even delivery of medications. An insulin infusion of 2 ml's an hour will deliver more evenly when titriating vasoactive drips with swings of 20 to 50 ml's an hour on occasion.

Okami_CCRN, BSN, RN · Jul 4, 2016

I was always taught that any drip should have a saline KVO to facilitate delivery. Often times we will have Norepi, Fentanyl, Propofol and NS at 15 going through one port. It also makes giving abx that may be compatible with all three drips easier by already having a KVO that you can just piggyback.

Wrench Party · Jul 5, 2016

Depends on where I'm working between two hospitals. One place on a cardiology floor, piggybacks are the norm with a carrier, with the exception of cardiac drips running at a sufficient rate. We do a lot of Abx, Mag, K sup in addition to Lasix, pressors, heparin. The pumps are easier to set up with primary and secondary, and won't alarm unless specified when rolling into the KVO primary.

Other place, the providers are always worried about their post-surg patients getting too wet, and the patients are usually pretty PO-capable, so primaries are the norm. I very rarely see a carrier for anything, with maybe the exception for PCAs and insulin drips. Since nearly everyone comes out of the unit with a PCA or epidural, I'm a huge fan of Y-siting compatible lines into each other.

marienm, RN, CCRN · Jul 6, 2016

We do it based on our discretion (& ask for an order if we think a carrier is needed).

Examples- If we're running a pressor, we're probably running some kind of maintenance (or perhaps bolus) IV fluid as well. If the pressor is compatible with the fluid, I'll connect them via a stopcock and I wouldn't ask for a carrier. (If the fluid is bicarb, they're probably not compatible...). If we were giving a pressor with no other IV fluid (or only incompatible options), I'd definitely ask for one, especially if the rate of the pressor was typically

Our Insulin gtt policy calls for the pt to be receiving a source of dextrose. If they have a tube-feed, then that counts. Otherwise, they're probably getting D5+KCl. I'll put the insulin into a stopcock with the maintenance fluid & not ask for a carrier.

Why the stopcock? Our tubing does have a Y-site about 6 inches away from the distal (patient) end. But it's too easy to, say, connect the maintenance fluid to the pt's arm, and then Y-in an insulin gtt that's running at 2 units an hour above that, and then have an urgent situation and inadvertently connect some bolus tubing above the insulin, effectively bolusing the pt with all the insulin that's in the 6 inches of tubing. Probably only(!) a couple extra units of insulin, but what if it were vasopressin? Anyway, I like the stopcock!

Okami_CCRN, BSN, RN · Jul 8, 2016

I also like to use a stopcock, but it seems that whenever I put one on a patient another nurse takes it off because they dont like using them. Quite annoying when you're working back to back with the same assignment.

MaxAttack, BSN, RN · Jul 9, 2016

I also like to use a stopcock, but it seems that whenever I put one on a patient another nurse takes it off because they dont like using them. Quite annoying when you're working back to back with the same assignment.

I wasn't taught about stopcocks initially; I learned how/why to use them from AN (thanks guys!). I think I'm the only one using them, and this drives me crazy when someone removes them.

Wuzzie · Jul 9, 2016

Stopcock manifolds are the best!

Axgrinder · Jul 9, 2016

I also like to use a stopcock, but it seems that whenever I put one on a patient another nurse takes it off because they dont like using them. Quite annoying when you're working back to back with the same assignment.

Stopcocks are awesome, and very handy. I love em.

When I was a new grad I followed a RN (also a new grad, same year but different school) who decided all IV tubing didn't need hub to hub connectors - she felt the proper way was to attach 20 ga needles to the ends, and tape them together! We argued a good long while at shift change regarding what was proper procedure. I removed all the needles, reconnecting hub to hub - only to have her replace all needles and tape them up on her next shift the following day. This may have gone on indefinitely - until my charge nurse, who was helping me to scoot this pt up in bed immediately after the next shift change, ended up with a needle in the palm of her hand - as one had become untaped and worked itself lose.

Needless to say, this nurse got an in service on the proper way to connect IV ports soon therearter. And sadly, my charge nurse had to go to employee health - to be screened for HIV, and Hep B.

arnwest · Jul 11, 2016

Our CVICU uses an anesthesia stopcock system - kind of. They stopcock all of the compatible drips together (one is always a carrier) and tape the line of stopcocks to the IV pole so it's just one line running to the patient's central line. Fewer tangled lines, easier to keep your drips from getting mixed up, and everything gets to the patient faster (or at least you see your titrations faster). So much of a better system than what we use in the MSICU - putting all the stopcocks directly to the hub of the central line with all the different IV tubings going from the pump to the patient. Everyone has their own thing I guess!

Julius Seizure · Jul 11, 2016

Our Insulin gtt policy calls for the pt to be receiving a source of dextrose. If they have a tube-feed, then that counts. Otherwise, they're probably getting D5+KCl. I'll put the insulin into a stopcock with the maintenance fluid & not ask for a carrier.

Thats interesting, because at my hospital we are told not to infuse insulin into the dextrose line, as the insulin will act on the dextrose in the line before even reaching the body. I always just took that for the truth. Wonder if it's a real thing, or if my hospital just made up a weird rule.

MaxAttack, BSN, RN · Jul 11, 2016

Thats interesting, because at my hospital we are told not to infuse insulin into the dextrose line, as the insulin will act on the dextrose in the line before even reaching the body. I always just took that for the truth. Wonder if it's a real thing, or if my hospital just made up a weird rule.

I mean, it would make sense if insulin and dextrose worked together that way, but insulin works to bring glucose into cells by activating receptors on the cellular membrane. Insulin can't "consume" dextrose or vise-versa in the line. Give them a B+ for trying?