With the use of Trialysis catheters in a cutecare the topic of compatiblity comes up often..... Calcium and citrate for example. I remember years ago seeing some study data of drug delivery with TPN infusion through triple lumen catheters. Cannot begin to figure out where to get the info that might help us with this topic in CRRT patitnts. Anyone have any input on this?
Your question is not very clear, but rules for compatiblity do not change because of the device. Dialysis catheters are central lines, their tip is in the RA. The third port on some of these new ones will exit in the SVC. Compatability rules need to be followed.
If you have questions about the use of the catheter your hospital is using, ask the Purchasing department to have the rep or clinical specialist for the company come in to give you a free inservice, that is what they are there for, they are the experts in their devices, use them!
Chris Cavanaugh, RN, BSN, CRNI, VA-BC
Calcium IV is known for many incompatibilities. When calcium is added to any PN solution, there are many factors to be considered especially the amount of calcium. Actually I think you would find a significant amount of information about drug compatibility. If you are asking about compatibiity when infusions given through separate lumens meet at the catheter tip and mixes together in the bloodstream. More than 20 years ago, there was a study of infusing incompatible meds through a model of the circulation in the chest with a double lumen CVAD in place. There were some formation of precipitate at the catheter tip and this formation was not seen in the CVADs that had staggered lumen exit ports. Also think about the separation of these sites on most CVADs. Hemodialysis catheters have the widest separation between lumen exit ports, yet about 25% of whole blood is picked up and recirculated a second time through the dialysis. To me, this says there could be mixing of infusates at the catheter hub. Then again, think about the 2000 mLs per minute of blood flow in the SVC and the huge amount of hemodilution in the circulation. With that food for thought, maybe you can clarify specific questions. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Thanks Lynn for the reminder. I knew there had been something done. We often are asked to put another central line in to infuse the calcium during CVVHD and yet both tips reside in the SVC. Everyone seems to think thatis fine. If that was fine then why would it not be fine to use the infusion port on the trialysis catheter? Really there is no good scientific data on these types of infusions.
Jose Delp RN BSN VA-BC