Y Site

[Sophie Garcia]

Can you please explain Y site-ing IV tubing? I was working with my preceptor the other day and, because the patient had an IV infusion of heparin running in his left antecub, she told me to Y site the magnesium into the heparin tubing, as they are compatible medications. She said it is more convenient for the patient so that the IV pole can stay on that one side instead of using a different IV site on the opposite arm. How does Y site work? Wouldn’t the magnesium infuse at the heparin rate?

[NICU Guy, BSN, RN]

Think of the IV tubing as a highway and the Y-site as an on-ramp with a toll booth that only allows X number of cars onto the highway per minute. It doesn't matter how fast the cars go once they get onto the highway. You are concerned about how many of those cars are allowed to enter the highway per minute. The Magnesium will only infuse at the rate that the IV pump is set for. It will not infuse at a faster rate just because it is Y'ED into a faster running IV line. You are confusing amount of medication in the line vs the velocity of the medication in the line.

[KeepinitrealCCRN]

Maybe not the question you asked but I would never Y site anything to a heparin drip.  I always run heparin alone even if it is compatible with other medications.  

[MunoRN, RN]

On 9/29/2021 at 1:23 PM, KeepinitrealCCRN said:

Maybe not the question you asked but I would never Y site anything to a heparin drip.  I always run heparin alone even if it is compatible with other medications.  

Why?

[KeepinitrealCCRN]

Any high risk medications I run alone if possible no matter compatibility.

[chare]

1 hour ago, KeepinitrealCCRN said:

Any high risk medications I run alone if possible no matter compatibility.

Not trying to be argumentive, but why?  

[KeepinitrealCCRN]

Just now, chare said:

Not trying to be argumentive, but why?  

For me I don't think it is safe.  You have more medications running together, you might need to flush the IV site or if there's an emergency and you use that line to push meds through or hanging piggy back medications you might make a mistake.  Also changes in rates will push more or less medications through the line.

For example I would never Y site levophed to IV fluids but that is just me.  Of course some patients are hard sticks or you only have limited options so you have to do it.

[0.9%NormalSarah, BSN, RN]

I like to put pressors, inotropes, high concentration critical meds together on a lumen, then sedations on another, and fluids or low risk meds that can be flushed safely on another. (Obviously whichever ones are compatible.) Basically I always have a lumen on a central line or PICC or a peripheral that I could flush or draw from without pushing a med through that would cause a problem. Most heparin bags we run are pretty low in concentration, like 50 units per mL. If I couldn’t withdraw the drug before flushing, that’s a med I’d feel comfortable flushing a mL or two of perfectly safely. Think about it, even when setting the rates most orders instruct you to round to the nearest 50.

Now for something like a vasopressor or insulin, I’d always withdraw the drug from the line before flushing it if I absolutely had to do so. And as @NICU Guy said above, the y site with 2 different meds running won’t change any rates of infusion, that is determined by the pump. I loved his explanation!