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?

[Dranger]

Zosyn and Merrem run over hours. I am not going delay giving a time sensitive antibiotic because of being able to discern a low probability medication allergy.

[VANurse2010]

Dranger said:

Zosyn and Merrem run over hours. I am not going delay giving a time sensitive antibiotic because of being able to discern a low probability medication allergy.

Zosyn and Meropenum (typically) run over 30 min. everywhere I've ever worked. It depends on your facility.

[Dranger]

VANurse2010 said:

Zosyn and Meropenum (typically) run over 30 min. everywhere I've ever worked. It depends on your facility.

The initial bonuses for us do but all the doses after that are 3+ hours.

[VANurse2010]

Dranger said:

The initial bonuses for us do but all the doses after that are 3+ hours.

I've seen them ordered like that (over 3 hours) but the norm in every SNF, acute, and critical setting I've been in is 30 min.

It just depends where you are. I would agree that if they are ordered like that, then I would probably run them at the same time - although zosyn and merrem being ordered together would be very rare.

[CelticGoddess, BSN, RN]

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!

Please make sure you are flushing both lines regularly. I had a line go bad in 12 hours. (I drew labs at 0530 and per the day nurse, the lines had no blood return that evening. And that was with generous flushing.

As far as using all the lines: I work Onc, and we have used all lines, and still had to start a peripheral so the patient could get blood. We only dedicate a line to one infusion if they are getting continuous chemo, heparin, or TPN.

And most of the time, if a patient has a triple or quad lumen, on my unit, they are all being used for something.

[applesxoranges, BSN, RN]

I'd check on facility policy regarding the antibiotics. Usually they do not let you run two at the same time.

[AlwaysLearning247, BSN]

I always alternate which port I use with IV antibiotics. As far as I know the red port does not mean that it is for blood draws. Some antibiotics are safe to run together but I wouldn't do it!

[Dranger]

VANurse2010 said:

I've seen them ordered like that (over 3 hours) but the norm in every SNF, acute, and critical setting I've been in is 30 min.

It just depends where you are. I would agree that if they are ordered like that, then I would probably run them at the same time - although zosyn and merrem being ordered together would be very rare.

I wasnt referencing them being ordered together, that would be odd and redundant.

Either way, if two antibiotics are ordered at the same time I am going to give them both. No place I have worked has had policies against this. Penicillins and early gen cephalosporins are usually the biggest allergy culprits. Early gen cephalosporins aren't all that common in the places have worked for IV abx. Penicillins are mostly Zosyn and Unasyn combos.

[VANurse2010]

Dranger said:

I wasnt referencing them being ordered together, that would be odd and redundant.

Either way, if two antibiotics are ordered at the same time I am going to give them both. No place I have worked has had policies against this. Penicillins and early gen cephalosporins are usually the biggest allergy culprits. Early gen cephalosporins aren't all that common in the places so have worked for IV abx. Penicillins are mostly Zosyn and Unasyn combos.

Personally, I think it's bad practice to give them together unless you have lack of time or lack of lines (usually the former is related to the latter) - but to each his own.

[Dranger]

VANurse2010 said:

Personally, I think it's bad practice to give them together unless you have lack of time or lack of lines (usually the former is related to the latter) - but to each his own.

If it was actually bad practice I am sure at least one of the facilities I have travelled to would have had a policy against it.

In addition with delayed reactions and abx allergies if there was a reactions all of the abx would be looked at as culprits no matter the time given. Whether they are given an hour apart or at the same time the reaction can be delayed until hours later (which I have seen

to each their own though .

[VANurse2010]

Dranger said:

If it was actually bad practice I am sure at least one of the facilities I have travelled to would have had a policy against it.

In addition with delayed reactions and abx allergies if there was a reactions all of the abx would be looked at as culprits no matter the time given. Whether they are given an hour apart or at the same time the reaction can be delayed until hours later (which I have seen

to each their own though .

I've seen people have immediate reactions to IV antibiotics, and just because your facilities don't ban it, doesn't make it good practice.

[applesxoranges, BSN, RN]

To be fair, I have heard of facilities with the triple lumen central lines sometimes having policy regarding what goes where but never the PICCs. Like the nurses couldn't remember if it was blue or white was for TPN if they had it and brown was usually for CVPs if they had that.