For example, maintence line of normal saline and MD orders Heparin drip for DVT. We used to always say put the lower rate fluid to closest port at INT then place other fluids higher to make sure medications does not reflux back up tubing. Has this philosophy changed or should we still be placing heparin first with fluids plugged in to that. Is this best idea to have the maintenance line first with other meds piggybacked in. Is there a right or wrong answer? What does every one think.
Why do you even have the "maintenance" fluid? Is this another prescribed fluid or something that you do by your customary procedure? If there is no valid clinical reason for these additional fluids, there is no need to use a "maintenance" fluid at all. Just connect the heparin infusion directly to the catheter, use an infusion pump to regulate the rate. My father was just discharged from an Atlanta hospital yesterday where he had a heparin drip with this same set-up - no maintenance fluid because he did not need any other fluid.
When you have multiple fluids infusing through the same catheter lumen, it really does not matter what fluid is attached to the lowest port. I am assuming you are talking about gravity infusion. As long as there is a pressure gradient - the fluid containers at about 3-4 feet above the patient, it will exert about 2 psi of infusion pressure or 100 mm Hg - peripheral venous pressure in the hand and forearm is around 35 mm Hg. So the infusion pressure is greater than the venous pressure creating a pressure gradient.
Add an infusion pump and that will change this situation though. The infusion pressure on most pumps is usually less than 5 psi but this varies by pump. But the port that is used does not really matter.
Lynn Hadaway, M.Ed., RN, BC, CRNI
www.hadawayassociates.com
Lynn Hadaway, M.Ed., RN, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861