Using Both Ports Of Central Line

[NurseQT]

I work in a SNF and we frequently have patients admitted with central lines and orders for IV ATBs. We use the IV infusion balls rather then pumps. Most of our patients will have double ports, a "purple" port for infusion and a "red" for blood draws. We currently have one patient who has orders for two seperate ATBs, one of the nurses apparently runs both ATBs at the same time, by connecting one to each of the two ports. The rest of us agree that this is not the correct procedure and that each ATB should be infused seperately and the red port should only be used for lab draws. What are some thoughts on this?

[Asystole RN]

The colors do not mean anything on the Bard PowerPICC (sounds like what you are describing) and are only there so that you can differentiate the two for charting.

Running two concurrent IV ABX should be done with caution but is perfectly acceptable.

Asystole BSN, RN, CRNI, VA-BC

[Dranger]

I use the red lumen (assuming that's the power PICC lumen?) all of the time for medication. Just flush it before and after and waste with blood draws. Alteplase as necessary.

What is the issue? I am not going to use 50 stopcocks just to leave one lumen open. I also frequently infuse multiple abx into a central line at the same time.

I have never seen a lumen left unused (if needed) before in my time working critical care.

[flyersfan88]

The only time I've seen a lumen used for one thing only is when a pt is receiving TON and they have a "TPN only" lumen. Red does not mean "blood draws only".

[Penelope_Pitstop, BSN, RN]

It's perfectly fine...however...I have always tried not to run antibiotics at the same time if I can help it reason being if there is a reaction to the drug, I have a much better chance of knowing which drug it is.

Dedicated lines I've only seen with Veletri, TPN and Heparin.

[AnnieOaklyRN, BSN, RN, EMT-P]

My concern with running two antibiotics simultaneously would be if the patient has an allergic reaction you will have to discontinue both, since you will have no idea which one is causing the reaction! I think one at a time is a safe plan!

Annie

[melizerd, ASN, RN]

Most of my patients that have multiple line PICCs have them because we need to run several things at once, even things that wouldn't be compatible otherwise.

[NurseQT]

We've used the "red" port to infuse meds in the past but have typically been told not to unless absolutely necessary. The only time we have central lines is for long term ABX and the patients almost always are admitted with a double lumen line... It's a first for us to have a patient on multiple IV ABX meds so infusing simultaneously is nothing we've had to think about.. And since we've always been told to only use one of the ports for infusing we figured it was a standard practice not to infuse using both ports at the same time.

Thanks for the info!

[Penelope_Pitstop, BSN, RN]

NurseQT said:

we figured it was a standard practice not to infuse using both ports at the same time.

Thanks for the info!

I've had lines with four ports and have used all of them PLUS two peripherals simultaneously.

[VANurse2010]

NurseQT said:

We've used the "red" port to infuse meds in the past but have typically been told not to unless absolutely necessary. The only time we have central lines is for long term ABX and the patients almost always are admitted with a double lumen line... It's a first for us to have a patient on multiple IV ABX meds so infusing simultaneously is nothing we've had to think about.. And since we've always been told to only use one of the ports for infusing we figured it was a standard practice not to infuse using both ports at the same time.

Thanks for the info!

The reason you shouldn't do it is because if the patient has a reaction you don't know which drug caused it. There is NO difference between the ports in a PICC line - except that one may be used for power injections with CT, which is an irrelevant consideration in your setting.

[Here.I.Stand, BSN, RN]

We run infusions through the red port all. the. time in the ICU (assuming we're talking about a double lumen PICC; if it's a triple lumen CVC we use all three all. the. time.)

That said, I agree with those who say that running them at the same time is not best practice. If there's a reaction, how do you know which it was? I wonder too if getting them both simultaneously is harder on the kidneys? I've never looked into it, but wonder.

[Karou]

For some reason when I worked in LTC, this myth of the "red port" being for "blood draws only" existed also.

Two incompatible medications can run simultaneously through a central line/PICC line. That's exactly why a multiple lumen line is placed. Either port, or both ports may be used.

The issue with allergic reaction shouldn't be a problem in your setting, because this patient (probably) has already had doses of both antibiotics and has not had an allergic reaction to them. If it's the first time a patient is receiving the antibiotic then it's an issue, and unless emergent, we will hang the antibiotics separately to monitor for symptoms of a reaction.

Of course, you could ask pharmacy to time them so they don't end up due together. That's usually not a difficult thing to do. Sometimes it's not possible if there are multiple abx and they are frequent (q6) or run over a very long time (Zosyn and mermen are 3 hours in my facility, a high dose Vanc may be 2 1/2 hours).