I was recently asked to start a PIV, for a patient with a double lumen PICC, as the pharmacy said the drugs were not compatable, even going into separate ports of the PICC.  We started the PIV, however, I still wonder if anyone else has had an issue as this. 

I am not sure that this is

I am not sure that this is really helpful, but we had similar situations in the past with pharmacists saying that incompatible drugs given via dual lumen PICCs were not OK.  They believed that it was only a Y-port to 1 lumen.  After education about the construction of PICCs (and not having medial/proximal/distal lumens), they understood. After education, they understood that incompatibles were OK via dual lumen PICCs.

It has really been a long time ago that this was an issue.

Gwen Irwin

Austin, Texas

Drug compatibility

Drug compatibility information depends upon how you are infusing each drug. 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 is very little information about drugs mixing at the tip of the catheter in the bloodstream and producing an incompatibility.

 The information for meropenam states that compatibility has not been established for mixing this drug with any other drug, so don't do it. 

Yes, all multilumen catheters are separate channels from the separate catheter hub through the entire length of the catheter. The tip of a properly positioned PICC in the SVC will have ~2000 mL of blood flowing around it per minute. One would think that this would be sufficient to dilute these medications rapidly and prevent them from coming into contact at the catheter tip. However there is no documentation for this. I would recommend you work with a pharmacist that has access to the most recent compatibility information and knows how to interpret this data. Then you can make a decision about whether you want to infuse these drugs simulataneously through separate lumens of the same catheter. I am assuming you want to infuse both drugs at the same time so that the patient will only have to remain in your clinic for 30 minutes rather than infusing them sequentially to double the time in clinic. 

I would also suggest that these 2 drugs do not present a valid reason for having a double lumen catheter in this patient. They can be infused sequentially through a single lumen catheter without the added risk of managing 2 hubs and 2 lumens. 

Lynn Hadaway, M.Ed., RN, BC, CRNI

www.hadawayassociates.com

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

I have a similar question

I have a similar question regarding infusing incompatible drugs through separate lumens of a double or triple lumen picc line. I work for an out patient infusion clinic and we received new orders to infuse the following iv antibiotics:

 meropenem 2gm  IV daily and rocephin 2 gm iv daily

The package insert for meropenem indicates not to infuse any other medications while meropenem infusing. This patient has a double lumen picc line and from what I understood about double lumen picc lines, incompatible drugs could be infused simultaneously as long as they were infusing in separate lumens. Please clarify this for me and if you could provide a resource for me, that would be great. Thank you.

Jessica V.

You said in the original

You said in the original message that the patient had a double lumen PICC, right? One lumen was used for TPN and nothing else should be infused through that lumen. Was there another continuous infusion or intermittent meds going through the other lumen? And then you had a third continuous infusion that required the PIV? I would need to know all the infusions before I could really provide a good answer. The one thought I had when reading your second message that the pharmacist was thinking that the new infusion should not go through the TPN. If so, that is absolutely correct for reasons of drug incompatibility and infection prevention. But that should not have prohibited the use of the second lumen unless there was an infusion through it that was known to be incompatible with the new order. You may have no choice but to use a PIV in some cases but I can't say unless I know all the drugs involved.  

 

Lynn Hadaway, M.Ed., RN, BC, CRNI

www.hadawayassociates.com

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

Thank you for your

Thank you for your response.  The fliuds were continuous, one was TPN and the other was to be continuous also.  The drug was acceptable for a PIV and that is what we did.  I am not sure what the pharmacist was looking at and he was the one to alert the team What site do you recommend should this come up in the future to keep as a reference.

 

 

Drug compatibility depends

Drug compatibility depends upon numerous factors. Since you did not provide the drugs in question, it is impossible to check the books I have for accuracy. 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. 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. 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. 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. Another thought is did the pharmacist know the pH and osmolarity of the drug in question? Was it acceptable for PIV infusion. There could be some situations where a PIV is needed,but cannot say with your situation without more information.  

 

Lynn Hadaway, M.Ed., RN, BC, CRNI

www.hadawayassociates.com

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