However there is no documentation for this. One would think that this would be sufficient to dilute these medications rapidly and prevent them from coming into contact at the catheter tip. The tip of a properly positioned PICC in the SVC will have ~2000 mL of blood flowing around it per minute. Yes, all multilumen catheters are separate channels from the separate catheter hub through the entire length of the catheter. The information for meropenam states that compatibility has not been established for mixing this drug with any other drug, so don't do it. There is very little information about drugs mixing at the tip of the catheter in the bloodstream and producing an incompatibility. For instance, Trissel's Handbook of Injectiable Drugs provides information when 2 drugs are mixed in the same fluid container, mixed in the same syringe, and when one drug is given through a Y-site of the administration set infusing another medication. There could be some situations where a PIV is needed,but cannot say with your situation without more information.ĭrug compatibility information depends upon how you are infusing each drug. Another thought is did the pharmacist know the pH and osmolarity of the drug in question? Was it acceptable for PIV infusion. One of the books on drug compatibility provides information about 2 drugs mixed in the same solution container for infusion, 2 drugs mixed in the same syringe for injection, or one drug given through the injection site on the tubing of another infusion. But the situation may be totally different if each lumen had a continuous fluid and the new drug must be piggybacked into one of these infusions. Did this patient have 2 continuous infusions going thru the PICC? If one lumen was being used for intermittent meds, and the new med was also intermittent, there should be no reason why the drugs can not be infused sequentially through the same lumen. Length of time the drugs are in contact, sequence of mixing, sources of energy such as light will have an impact of the stability of the drugs in question. Since you did not provide the drugs in question, it is impossible to check the books I have for accuracy. Woops! I never like to spread incorrect info.Drug compatibility depends upon numerous factors. I must have been thinking about a single lumen PICC. I know this is a different population, but the IV compatibility issues are the same. We try to interrupt the line as infrequently as possible to reduce infections, so we use a closed med line system and a 30 second scrub of the hub. There are some incompatible that require a separate lumen or line, such as Ampicillin or Versed, but this doesn't mean there should a blanket rule. We ROUTINELY run drips and give meds with our TPN, assuming they have tested compatible. In the NICU, we use TPN as our maintenance fluids and often have limited access for pressors/meds/etc. It seems like a waste to add a PIV when you have three lumens that empty separately into the vein. The whole point of the three lumens is to be able to run things that are non-compatible. The rationale that I learned was that many meds are not TPN compatible and may not be as effective. One previous poster that it was due to infection, but I am not clear on how this would be (doesn't s/he wasn't right). As a general rule (a few exceptions possible), the only thing that should run with TPN is normal saline. However, I do agree that you should never have TPN and another continuous IV med going at the same time, even if they have a triple lumen PICC line.
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