Which port is used in a triple lumen central line?

[Kenneth Oja, PhD, RN]

It's important for nurses to understand the lumen configuration and designation when caring for a patient with a triple lumen. When I worked in the ICU, patients were often receiving multiple medications and fluids at once, so a triple lumen central catheter, and knowing the function of each port, was essential.  

This may vary by manufacturer, but typically each lumen of the catheter is a different color, its own separate line, and used for designated purposes.  

Color	Location	Gauge	Designation
White	Proximal	18	Medications, IV solutions, and blood products if other lumens are not open.
Blue	Medial	18	Medications, IV solutions, more viscous fluids like TPN and lipids, colloids, and blood products if distal lumen is not open.
Brown	Distal	16	Medications, IV solutions, lipids, and colloids. Always first for blood products if open. Also used for blood draws and monitoring central venous pressure (CVP).

 

 

 

 

 

 

 

 

 

Hope this helps! But, most likely, you will never forget which port is used for what after getting questioned in clinicals! 

[RNPATL, DNP, RN]

If I remember correctly, the triple lumen has a proximal, medial and distal port. The proximal is the brown cap and is used for blood draws, the distal (white cap) is the port used for infusions like TPN and the medial port is used for routine fluids and IV meds on a pump.

Of course, once you get into practice, nurses use all of the ports sometimes without regard for their intended use.

[gwenith, BSN, RN]

Be careful not all lumens are marked with the same colours!!!! Ours is brown - distal and is used for monitoring

The distal is always for monitoring and for blood administration as it is the largest lumen (usually) In the absence of monitoring it is used for TPN.

TPN should never be given through the proximal port as it is the most likely post to be displaced into the tissues and TPN, due to the high dextorse content will "burn" if it tissues.

Inotropes should be placed on a lumen by themselves and usually a medial lumen, again because many of the inotropes (most actually) will burn if tissued. Inotropes are NEVER placed on the same lumen as the monitoring as they may be accidentally "flushed"

Hope this helps.

[Jay-Jay, RN]

Last patient I had with a triple lumen Hickman was on 24 h. a day Pen G for an infection. He was very heavily anticoagulated for severe CAD, so we could not use a peripheral IV on him. (The Hickman insertion site bled so profusely that he wound up in the hospital for a few days! Never SEEN such a bloody mess!) We rotated the IV pump from one port to another every time we did the tubing change (every 72 hours). The idea was that the rotation would help keep the ports patent.

Edited to add: I believe the size of the lumen is marked on the catheter, just below the cap. So, never mind the cap colour, look for the gague! The largest will be for drawing blood or giving TPN.

[pghfoxfan]

I agree , be careful. Our Brown port was to be saved for Hyperal.

[I_Love_Donuts]

ok...a port is a port-a-cath, completly under the skin and is accessed with a needle...it's a single lumen central line. I think you are talking about broviacs here...

[MarkHammerschmidt]

First concept is that with regards to the position of the ports, the normal idea of distal and proximal is reversed. Like, normally, the fingers are distal to the elbow, right? Further away from the center of the body?

Not so with multi-lumen lines. The ports are described in relation to the insertion site - where the line enters the patient. So the port that opens up at the tippy end of the line - which is the brown-ended one on an Arrow multilumen - that's the distal port. The blue one is medial, the white one is proximal - closest to the site of insertion.

Next: you wanna use the brown port for your CVP transducer, on account of it's the largest lumen, also it's looking straight down into the RA. Make sense? We use them for intermittent med infusions like antibiotics, etc., never for pressor/vasoactive drips.

Blue and white ports can be used at your preference. I never heard of TPN "burning" anyones vasculature in relation the port chosen - I been hanging TPN for a long time, too. Doesn't ring no bell.

An important point: don't run anything into a central line lumen without checking that there's a good, visible blood return. Suppose you turned your patient over and the line took a yank, got pulled out a couple of inches. If you were infusing pressors through the proximal port - perfectly OK in a properly situated line - and those pressors now began infusing into the tissue on account of the port was pulled back out of the vessel - that would be a bad thing. As a stopgap you could switch the pressor infusion to the distal port, get your x-ray, and think about getting the line replaced.

[gwenith, BSN, RN]

Hi ya Mark - The one about the TPN I got from one of the "educational videos" that was doing the rounds some years back but it made sense because the reason why we do not infuse TPN peripherally is that it will cause a 3rd degree burn if it extravasates - my early years in ICU (you know when there were dinosaurs around) I actually saw extravasation of 50% dextrose on a peripheral site - nasty nasty burn!

[RNPATL, DNP, RN]

Quote

Originally posted by Zee_RN

I was always taught distal for blood draws, medial for TPN and proximal for IV infusions. But I don't think that is a "hard and fast" nursing rule; the safest answer would be "CHECK COMPANY POLICY." I have seen all three ports used for all three stated uses. If you do have CVP readings, you must have your transducer connected to the distal port.

I have to agree with your post .... checking the facility's policy is certainly the way to go. I know that my facility policy is slightly different than some of the posts here. Good call.

[Jay-Jay, RN]

Also, the way it is in RL isn't always the same as in the books, as you've no doubt realized from reading our replies! The important thing to ask is "okay, this is different from what I was taught. Is it still safe for the patient?"

[luanne123]

I have been an RN for 15 years (ER now). I rarely use central lines now and that was a good refresher course for me. The most we do in the ER is put the line in and send them off to the unit!!

Luanne

[canoehead, BSN, RN]

Yet another point of view- I have been told to alternate the ports you hang the antibiotics from so that each lumen gets a dose, and there is no space for the bugs to crawl into and hide.