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 I have never seen any published studies on this issue. Your evidence would come from the manufacturer's instructions for use, which is a booklet included within each catheter package. You can also obtain most of these instructions from the manufacturer's website. The most important recommendation is for drawing blood samples from a VAD. If you have a catheter where the lumen exit sites are staggered, you would draw blood from above the lumens being used for infusion. Most of these staggered lumens are labeled as proximal, medial, and distal. The engineer designing the catheter is the point of reference. Therefore proximal and distal are reversed from what nurses have been taught. The extension leg labeled as proximal should be the one where you draw blood. What you infuse through the other lumens is not a critical issue. The other issue is the size of the lumen and this applies mainly to CVADs with non-staggered lumens. Use the largest diameter lumen to draw blood samples. Again, which lumen you use for infusion is not a critical issue. For both staggered and non-staggered, if you are infusing solutions that have known serious incompatibility, those drugs may be problematic if infused at the same time because they can come into contact with each other at the catheter tip. Lynn