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Kathy,
Funny you should give that example. While treating a patient in the ER trauma room one cold winters night with a full moon (ok, so I am exaggerating a little) the nurse I was working with placed one of these pipe lines in our MVA patients right AC, upon admit. She pushed Dilantin (appropriately diluted per pharmacy) in one lumen while infusing methylprednisolone in the other. The site almost immediately clotted off through both ports. We had the central line in a few LONGGGGGG minutes later, so we were ok, but when we took that catheter out later, it was hard as a rock! The dilantin had crystalized solid. We put it up for everyone to see for a few weeks after that. I do not believe after actually using these catheters several times, that there is enough flow around them to safely infuse incompatible meds through them. Just my little ole opinion though.
Heather Nichols RN BSN CRNI
Infusion Services University of Louisville Trauma Institute 530 S. Jackson St. Lou. Ky. 40202 (502)562-3530 >>> "Kokotis, Kathy" <[EMAIL PROTECTED]> 10/7/2006 10:27 AM >>> Thanks for the article - I need to read the full article to get a handle on the testing methods and the author's background - but I may be off base on the drug intermixing. I wonder if the same thing would happen with Dilantin. I assume they do not suggest giving vesicants via this device?
At least the antecubital vessel used in this study is large and has a higher hemodilution than the lower arm but that is not a great site for an IV. In essence the author is suggesting the usage of the antecubital vessel and not the lower arm vessels for the Twin Cath product. For an outpatient I can see the usage of this product for an inpatient I would have to evaluate the length of therapy, underlying medical conditions, etc. The only time I have seen this product used was for outpatient angioplasty.
Looked up the drugs in Trissels and they cause immediate turbidity and precipitation when in contact with each other
I assume this was a laboratory test model and not an animal study?
Kathy  Confidentiality Notice: This e-mail and any attachments are intended only for the use of those to whom it is addressed and may contain information that is confidential and prohibited from further disclosure under law. If you have received this e-mail in error, its review, use, retention and/or distribution is strictly prohibited. If you are not the intended recipient, please contact the sender by reply e-mail and destroy all copies of the original message and any attachments.[v1.0]
From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of [EMAIL PROTECTED]
Sent: Saturday, October 07, 2006 6:14 AM To: [EMAIL PROTECTED]; [EMAIL PROTECTED]; [EMAIL PROTECTED]; [EMAIL PROTECTED] Subject: Re: Inquiring mind While I question the use of the appropriateness of a dual-lumen peripheral catheter for many reasons, there is one article in the literature that speaks to the issue of incompatibility.
Jim
Prince, R. A., D. S. Lucas, et al. (1998). "Effect of a dual-lumen peripheral catheter on the delivery of known incompatible medications." Ann Pharmacother 32(9): 875-7.
OBJECTIVE: To determine the degree to which a dual-lumen peripheral catheter prevented precipitation of solutions known to be incompatible due to pH during simultaneous infusion in an in vitro model. METHODS: An in vitro model was devised to simulate peripheral venous blood flow from an antecubital source to systemic circulation. Ondansetron was simultaneously infused with fluorouracil, aminophylline, sodium bicarbonate, and ampicillin sodium in concentrations reflective of clinical conditions into the Twin Cath 20/22 (the dual-lumen catheter used in this experiment). Study solutions were primed with the prepared drug solution and administered for 15 minutes. Phase I used Normosol-R as the diluent to gather preliminary data; phase II used human plasma. All samples were obtained immediately before the start of the infusion and at 5, 10, and 15 minutes during the infusion, and 5 minutes after the infusion. Samples were visually inspected at each time point for precipitation and analyzed in duplicate by the appropriate stability-indicating HPLC method (except for sodium bicarbonate). Compatibility was defined as no visual evidence of precipitation and no more than 15% mean change in final versus initial concentration. RESULTS: Phase I experiments showed immediate precipitation in Normosol-R within the venous flow. However, in phase II, because of the buffering capacity that plasma proteins add to plasma, no precipitation occurred. All the drug combinations used in this study have been reported to be incompatible at the concentrations tested; however, we detected no incompatibilities. CONCLUSIONS: The results of this study indicate that using a dual-lumen peripheral catheter, such as the Twin Cath, may allow solutions incompatible due to pH to be administered simultaneously.
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