Why it is not a wise idea to run incompatible drugs via the
Arrow Twin Cath
The vessel that the twin cath is placed in lies in the
lower forearm basilic or cephalic, metacarpal, or
antecubital
The size of the vessel is 2 mm to 8 mm which is
compared to the size of the SVC at 20 mm in size in a healthy
adult
The blood flow around the twin cath placed peripherally in
the lower arm would result in 20 - 100 ml/min versus the SVC at 2,000
ml/min
Intermixing of incompatibles would
occur
Intermixing of incompatibles in the blood stream is not
related at all to two separate lumens
Two separate lumens only prevents the drug from intermixing
in the catheter itself not the blood stream
The higher rate of phlebitis is actually related to flow
dynamics and vessel size - which in turn hemodilute the pH and osmolarity of the
drug
Feel the end of the tip of the catheter and the vein and
you are likely to find it is hard - that is chemical intermixed drugs that have
precipitated if incompatibles have been run. By the way this is often seen
with Dilantin a largely unstable pH drug.
Take it from an ex -Biology and Chemistry school teacher -
drug pH, osmolarity, vessel size, distance to the SVC, and flow rate dynamics
play a large part in vascular access.
By the way there is no research at all to suggest that
staggered lumens reduce the risk of drugs intermixing in the vein. It is
all about the flow of the SVC that prevents drugs from intermixing.
Sometimes these drugs intermix even in the SVC as patients have
medical conditions that reduce their blood flow
Maybe Lynn Hadaway can also enlighten us on this subject in
case my facts are not 100%. Her anatomy background is as good as my
chemistry background
As angioplasty is largely an outpatient procedure and the
drugs are normally compatible the twin cath may be used but one has to weigh the
risk of phlebitis/thrombosis of the vessel versus two sticks. There is no
perfect answer. I would not use this catheter for an
in-patient.
Kathy
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From: [EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED] On Behalf Of Jenny
Graziani
Sent: Friday, October 06, 2006 6:03 PM
To: [EMAIL PROTECTED]; [EMAIL PROTECTED]
Subject: Re: Inquiring mind
Sent: Friday, October 06, 2006 6:03 PM
To: [EMAIL PROTECTED]; [EMAIL PROTECTED]
Subject: Re: Inquiring mind
We frequently use Twin Caths at our hospital, especially for patients going for angioplasty and needing 2 peripheral IV sites...They are two separate lumens, one proximal one distal, and you can run incompatibilities as each lumen exits separately. I find that the catheter has a lot of "drag" when you put it in, and they seem to get phlebotic sooner than two separate IVs. Good for short term IV access in patients with nice big veins!!
Jenny Graziani
Monongalia General Hospital
Morgantown, WV
From: "Cindy Schrum" <[EMAIL PROTECTED]>
To: [EMAIL PROTECTED]
CC: [EMAIL PROTECTED], [EMAIL PROTECTED], [EMAIL PROTECTED]
Subject: Re: Inquiring mind
Date: Fri, 6 Oct 2006 09:04:23 -0400
>So with a twin cath you have 2 IV's? Really just 2 ports right?
>Because you can't give incompatibles through a twin cath.
>
>I don't understand the benefit of a twin cath versus a piggyback at
>a
>Y-site. Larger catheter, more risk of complications. I've never
>used
>them or been where they were used with any consistency. It seemed
>to
>be an ED thing.
>
>Can someone explain the benefit to me and tell you how they have
>worked for you?
>
>On 10/5/06, [EMAIL PROTECTED] <[EMAIL PROTECTED]> wrote:
>> We use the Arrow Twincath which has an external pigtail and has a
>>20g and
>>a 22g lumen. They work great for when we need two PIV's for
>>patients that
>>are on the Alcohol withdrawal pProtocol and you need two lines.
>>
>>Betsy Harmon RN CRNI
>>Vascular Access Team
>>Critical Care Unit
>>Alaska Native Medical Center
>>Anchorage, Alaska
>>[EMAIL PROTECTED]
>>
>>Original Message:
>>-----------------
>>From: Cofield, Louise [EMAIL PROTECTED]
>>Date: Wed, 4 Oct 2006 09:52:00 -0400
>>To: [EMAIL PROTECTED], [EMAIL PROTECTED]
>>Subject: RE: Inquiring mind
>>
>>
>>Could it be "Twin Cath" manufactured by arrow ; manufacture #10998?
>>
>>
>> Louise P. Cofield RN BSN , CMSRN
>>St. Francis Hospital
>>Clinical Educator Med/Surg
>>Ext 6166 Pager# 390-1167
>>
>>-----Original Message-----
>>From: [EMAIL PROTECTED]
>>[mailto:[EMAIL PROTECTED] Behalf Of Julie Steele
>>Sent: Wednesday, October 04, 2006 9:14 AM
>>To: [EMAIL PROTECTED]
>>Subject: Inquiring mind
>>
>>
>>Anyone remember the name and manufacturer of the dual lumen
>>peripheral IV
>>catheter from about 15 years ago? It had a blue hub on the external
>>pigtail.Thanks, julie
>>
>>
>>
>> _____
>>
>>How low will we go? Check out Yahoo! Messenger's low PC-to-Phone
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