Y's vs. Stopcocks

My NICU uses all two & three ways. The CICU/PICU uses stopcocks. I had a kiddo once in the NICU who was on so much stuff that it was a mess, also I felt like keeping the pressors in the front of the line would help him out so I changed to stopcocks. We continued this for a few days until one of the educators found out and freaked out. No where in our policy does it say you cannot do that and she wouldn't give a reason but said we "couldn't do that" in the NICU (she also gave some bogus response that the cicu/picu had "different" stopcocks...umm no). I really don't think it makes a difference and I prefer stopcocks though I do think because of them the whole train doesn't get changed as often and that we break into our lines more in the cicu, waaaay more than we break lines in the nicu, while I haven't noticed an increase in CABSI between the units it is something I think about.

I'm certain that when you use the line of stopcocks, you're going to have backflow into the slower-running lines. I've said this from the beginning of my career, and finally got the chance to prove it one night.

We had a baby on Dopa, Dobu, Fentanyl, Versed...all running in the 0.1-0.3 ml/hr range.

We had TPN running at 10 or so. We had Lipids running at 1 or something.

The TPN was of course the main line off of which the stopcocked pressors, lipids and sedation were running. Lipids farthest from the baby, then sedation and then pressors closest to the runt.

When I changed all the tubings, and set the stopcocks back up the same way...i watched (with a doubting coworker) as the lipids began to (fairly rapidly) backflow into the fent, versed, dobu and dopa tubings.

The kid's b/p had been brittle all night, and we were maxed out on the pressors. After I removed the stopcocks and set up my lines with y-connectors, I was able to get control of the b/p within a 30 minute time frame, and started weaning quickly thereafter.

It depends on the situation. I don't think there is a higher risk of contamination with the stopcocks, we cap and clean them the same way we do any other entry point. When you use a lot of Y's, it requires more fluid and it takes the gtt farther from the baby, stopcocks are a shorter route, if you will. We use caps that help prevent backflow into other lines.

Most of our really sick kids don't get lipids, especially if they are septic, and I though lipids weren't compatible with Dop/Dob? At least our pharmacy doesn't recommend putting it.

The CNS where I work told me that stopcocks do raise the risk of central line infections so to try and avoid using them. I don't know where she got that information but she usually has research to back up her recommendations.

They can raise the risk of infection if the stopcocks are not changed with the line change, but if we have multiple gtts together, we change them all on the same schedule so that we can prime them all at the same time and change the whole kit and kaboodle at the same time instead of one this day and one the next. The CDC doesn't really sight multiple stopcock use as increase for infection unless the stopcock isn't changed with the line. Same for all your connections, they should be changed at least every 72 hours and this includes all caps on lines.

We don't use a line of stopcocks at all. We only use stopcocks on our PALS and UACS. Everything else has double and triple lumen Y connectors.

Sometimes we get kids back after PA banding. Only our preemies. They'll have a totally different set up. There's a big disk of stopcocks. Once the kid is settled, we change everything back to the way we do it.

As an ancient nurse, I can recall when stopcocks fell out of favor due to a significantly higher infection rate than Ys and extension tubings.