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?

[CamillusRN, BSN]

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!

Sounds like a facility policy issue.

If I have an open port, I use it. Especially when handling drips that don't play nicely with the others. I've never heard of a port being dedicated solely for blood draws (unless we start talking about Swans, which I'm sure we're not).

[CamillusRN, BSN]

Here.I.Stand said:

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.

Agreed. ABX infusions should be staggered, and you're right about the nephrotoxic ABX building on each other. High protein-binding abx like Ancef and Vanco both lower the renotoxic threshold, so giving them too close to each other can predispose acute renal failure. (Critical Care Nephrology, p 1690).

[iluvivt, BSN, RN]

Yes as others have stated it perfectly acceptable to administer medication in different lumens simultaneously. Hypersensitivity reactions often do not manifest until the second or third dose do keep that in mind.The blood flow is so rapid into the SVC the medication is quickly mixed as in enters into the bloodstream. The red lumen is not only for blood draws and I can't understand why nurses think this way. Even though the PICC is one catheter is divided into two or three lumens down the entire length.Next time you take one out ....take a flashlight and look at the tip and you will see what I am referring to.

[KelRN215, BSN, RN]

For the first doses, I can see not running them together because of the possibility of reactions but once you know the patient is not allergic to either, I don't see why you wouldn't if you have a double lumen central line and they're due at the same time. We do it all the time in the home. CF patients always seem to go home on multiple IV antibiotics. If they have a double lumen PICC, they'll do 2 drugs at once to cut down on the time they have to spend doing it. I have a patient now who's going to need to go home on nafcillin q 4hr and gent q 8hr. Q4 hr antibiotics in the home are infused via continuous infusion pump that runs KVO between doses. He will run the gent while still connected to the nafcillin. He's been on both in the hospital and we know he's not allergic to either.

[Julius Seizure]

The largest lumen on a CVL is generally the one you transduce for pressure monitoring (and easiest to draw blood from). Other than that, I've never heard anything about it mattering - you can still infuse through all lumens if needed.

And we run things concurrently with heparin and TPN when needed; we don't reserve lines as "TPN only" - but we often have limited access in pediatrics, so we don't really have a choice.

What on earth is an infusion ball? This is new to me!

[iluvivt, BSN, RN]

It's not an infusion ball but kind of looks like one.The medication is instilled into a plastic flexible tube that inflates once the medication is added by a pharmacist and the key it's it's under pressure.Once you hook it to any VAD and unclamp it's tubing it's r begins to release it's medication. There are different tubing rates so the pharmacist must select to correct one for the medication to be infused.They are used mostly in home care and the Brand I use now is called Eclipse.

[VANurse2010]

Janey496 said:

The largest lumen on a CVL is generally the one you transduce for pressure monitoring (and easiest to draw blood from). Other than that, I've never heard anything about it mattering - you can still infuse through all lumens if needed.

And we run things concurrently with heparin and TPN when needed; we don't reserve lines as "TPN only" - but we often have limited access in pediatrics, so we don't really have a choice.

What on earth is an infusion ball? This is new to me!

It's a device that releases IV medication at a controlled rate. It's for home care patients so they don't have to become competent with an IV pump.

[Libby1987]

KelRN215 said:

For the first doses, I can see not running them together because of the possibility of reactions but once you know the patient is not allergic to either, I don't see why you wouldn't if you have a double lumen central line and they're due at the same time. We do it all the time in the home. CF patients always seem to go home on multiple IV antibiotics. If they have a double lumen PICC, they'll do 2 drugs at once to cut down on the time they have to spend doing it. I have a patient now who's going to need to go home on nafcillin q 4hr and gent q 8hr. Q4 hr antibiotics in the home are infused via continuous infusion pump that runs KVO between doses. He will run the gent while still connected to the nafcillin. He's been on both in the hospital and we know he's not allergic to either.

It is interesting coming from the HH perspective, isn't it? We teach lay people how to competently administer combo abx therapy and managed their lines following established protocols and schedules in about 30 min while inpatient nurses can still be under trained and varied levels of nervous.

[chare]

VANurse2010 said:

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.

And just because you don't like it doesn't make it bad practice.

[VANurse2010]

chare said:

And just because you don't like it doesn't make it bad practice.

Just because you say it's ok, doesn't mean it is. Isn't this fun?

Whatever!

[/username, BSN, RN]

I know my unit is a bit different, but no, this is complete BS.

[Wrench Party]

News to me then! I've had milrinone, dopa, and another pressor running into a turkey foot through one lumen of a PICC, the other lumen was running 3 compatible Abx and antivirals all Y connected, and had another running heparin through a PIV.

This was on a new lung transplant fresh off the unit.