![]() This booklet is usually placed in the chart at the time of insertion (at least that's where we put it). There is also a booklet that accompanies each PICC insertion kit. Most PICC lines have one lumen that is slightly larger than the other. The minute any infused solution exits the PICC it enters the turbulent blood flow of the superior vena cava and is instantaneously mixed with the incoming blood flow going into the right atrium of the heart and is hemodiluted. The turbulence of the blood in that anatomical area makes the idea of any solutions getting intermingled moot. This can be confirmed by looking at the x-ray report because the placement of the catheter tip should have been confirmed by x-ray. Usually, it is in the superior vena cava of the heart. ![]() The answer to the question at hand ultimately lies in where the tip of the PICC line rests. Not ideal but then a lot of what we do is under less-than-ideal conditions.One of the reasons for inserting a dual lumen PICC is for the purpose of infusing two different solutions (including a blood and blood products) through each line at the same time. Some meds are compatible with TPN and lids and we have a list of them so they can be run together. which jacks up their infection risk hugely. If we need to give meds and have no other access it will be into the lumen with the TPN. Our transplant patients often have tacrolimus (which doesn't play well with others) in one lumen and ATGAM (which MUST run alone) in another. I'm not sure why your HIV patients would need a second site for antibiotics unless they had something else running into one of the lumens that couldn't be interrupted. The furosemide would be stopped and flushed for antibiotic or other incompatible med infusions. ![]() The only access we may have in a child is a triple lumen CVC through which we could be running TPN and lipids in one lumen, epinephrine, norepinephrine, milrinone, morphine, and midazolam in another and furosemide in the third. ![]() I've worked in PICU for more than 12 years and we run incompatible solutions into our lines all the time, as long as they're in different lumens. That essentially means that the line isn't a single line, it's three lines. The idea was to show how the lines are designed with the lumens completely separate from each other. Those pictures are cross-sections of two different types of multi lumen CVCs. It would seem somewhat counterproductive if the contents of the two lumens mixed inside the catheter in those circumstances now wouldn't it? Catheters used for hemodialysis and continuous renal replacement therapy have two large lumens that allow the aspiration of blood from one lumen and the infusion of blood into the other. They infuse into large vessels with rapid, high-volume blood flow that does not allow physical mixing of incompatible meds. Multi lumen central venous lines have completely separate lumens that exit the line at different spots along the side of the line with the largest lumen usually opening at the proximal tip. Something about a "huge catheter" in their neck is intimidating to some patients. You only have two possible femoral sites the it can go to the subclavian which usually freaks out patients. All the lumens go to the same central line so they would be mixing and if they are not compatible you just destroyed a perfectly good central line and your patient may be forced to endure another central line placement at a different site. If two medications are not "Y compatible" then you cannot run them at the same time into two different ports in the same central line access site.
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