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]

There is a difference between "bad practice" and "practice with caution." One must take into account the care settings and the how new the medications are to the patient and the patient status.

Treating a 40yo A+O BKA NKDA who has been on the same two ABX for 4 months is different than a 95yo renal failure with PCN and Sulfa allergies receiving two new ABX.

For those who say not to run duel ABX at the same time have obviously never had the pleasure of having to running continuous ABX like Nafcillin in conjunction with a Q4.

Reasonable and prudent is the standard, there is a balance.

[iluvivt, BSN, RN]

Yes...yes...yes it's OK to administer one abx in lumen and another in the other at the same time once you have established that the patient is not allergic to rither.We do it home care and the hospital all the time. As far as a dedicated lumen goes, once you select one for TPN then stick with that one for TPN from that point going forward. With mulit=staggered tip designed CVAD it's is best practice to blood from the most proximal lumen.That are the only two recommendations that with these types of designs. Sometimes you will see policies that state to use distal lumen for TPN...that's OK too...just don't change midstream and change it to the middle lumen.

[paidmydues]

Glad someone above talked about the blood flowing so fast that incompatible meds dilute quickly into the rapidly flowing blood. Therefore, the little openings in the line are located in different places and you can run all sorts of things in...that is the beauty and reason for a multi-lumen PICC! ABX tho I agree should be staggered. Even with a 4 hour Zozyn you can easily schedule another one later. USE all ports! That's what they are there for. They will be less likely to grow a fibrin sheath if used often and flushed properly (use a quite vigorous pulsing flushing method)

[IVRUS, BSN, RN]

It is very difficult to assess whether or not micro precipitates are forming at the end of a central line's tip while in vivo. This "usually" isn't seen as a cause for concern and it is less problematic if the lumens have their opening staggered vs. side by side.

However, companies who get approval for their IV catheters to go to market, don't have studies which show what happens when incompatible medications mix at the tip while in a patient. Very rapid blood flow in the SVC is said to be helpful in preventing precipitation formation, but who really knows.

[Asystole RN]

IVRUS said:

It is very difficult to assess whether or not micro precipitates are forming at the end of a central line's tip while in vivo. This "usually" isn't seen as a cause for concern and it is less problematic if the lumens have their opening staggered vs. side by side.

However, companies who get approval for their IV catheters to go to market, don't have studies which show what happens when incompatible medications mix at the tip while in a patient. Very rapid blood flow in the SVC is said to be helpful in preventing precipitation formation, but who really knows.

To be fair there are no studies that would suggest that tiny elves that live on the end of the catheter to keep the ends clear and precipitate free either. Hard to prove a negative.

Considering that the tip of any ordinary PICC is going to have literally thousands (if properly placed 15,000-20,000ml/minute) of turbulent blood passing by the tip of the catheter with each antibiotic most likely running well less than 10ml/minute (more likely well under 5ml/min) I HIGHLY doubt the chance for PICC tip precipitate formation or any chemical reaction for that matter for ABX. Even at the most conservative that is a dilution factor of 1/1,500.

There are reasons to not like trimmables but fearing drug precipitate formation at the tip is not one of them.

[IVRUS, BSN, RN]

Asystole RN said:

To be fair there are no studies that would suggest that tiny elves that live on the end of the catheter to keep the ends clear and precipitate free either. Hard to prove a negative.

Very true, it is hard to prove... But research on a myriad of topics occur every year, and then a change in practice is put into place which sometimes results in it turning the infusion world upside down. So, as of today, follow safe practice and the policies and procedures put forth by your organization.

[iluvivt, BSN, RN]

Tiny little elves....OK you are making me laugh now.Yes IVRUS' s statement is correct. I was reluctant to bring that up since I am so used to answering policy questions and how do I set this up questions but we must base our decisions on what we know now and what we can prove.