What would you have done?

  1. The other day at work I had a patient admitted for an infected hip prosthesis; he had a revision and was on IV antibiotics post-op. His medical hx included a cardiac valve replacement, so he was on a heparin drip. There was a student nurse assigned to the patient; the nursing instructor works per diem on my unit. His crit was 25 so I was getting ready to hang some RBC's. He had a double lumen PICC with the heparin infusing through one port, and I was infusing the blood through the other port. I was explaining to the student the protocol for transfusion when the instructor came in and said to the student "are you ready to hang his antibiotic?" I gently reminded her of the hospital policy that heparin must run alone (we can't piggy-back anything with heparin, insulin, blood or albumin) but she said "I called the pharmacy and they said heparin and ceftriaxone are compatible." I didn't want to argue or cause a scene, but I didn't think it was appropriate to set that kind of example for the student! So I said "let's wait until after the blood is done." The instructor took down the antibiotic and left the room. I'm don't know if I handled the situation right...
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  2. 20 Comments

  3. by   RNPATL
    Quote from Sadie04
    The other day at work I had a patient admitted for an infected hip prosthesis; he had a revision and was on IV antibiotics post-op. His medical hx included a cardiac valve replacement, so he was on a heparin drip. There was a student nurse assigned to the patient; the nursing instructor works per diem on my unit. His crit was 25 so I was getting ready to hang some RBC's. He had a double lumen PICC with the heparin infusing through one port, and I was infusing the blood through the other port. I was explaining to the student the protocol for transfusion when the instructor came in and said to the student "are you ready to hang his antibiotic?" I gently reminded her of the hospital policy that heparin must run alone (we can't piggy-back anything with heparin, insulin, blood or albumin) but she said "I called the pharmacy and they said heparin and ceftriaxone are compatible." I didn't want to argue or cause a scene, but I didn't think it was appropriate to set that kind of example for the student! So I said "let's wait until after the blood is done." The instructor took down the antibiotic and left the room. I'm don't know if I handled the situation right...
    I think you handled it great! I would not hang anything with Heparin either and your approach seemed fine. I would certainly question the nursing instructor. It is one thing for Pharmacy to say that both were compatible and quite another thing as far as what your facility policy is in relationship to hanging anything with Heparin. The instructor should have been a little more on the ball. I don't think you need to worry about what example you set, rather the instructor should be concerned about how she is guiding and teaching her studnets.
  4. by   Speculating
    Quote from RNPATL
    I think you handled it great! I would not hang anything with Heparin either and your approach seemed fine. I would certainly question the nursing instructor. It is one thing for Pharmacy to say that both were compatible and quite another thing as far as what your facility policy is in relationship to hanging anything with Heparin. The instructor should have been a little more on the ball. I don't think you need to worry about what example you set, rather the instructor should be concerned about how she is guiding and teaching her studnets.
    Dido, excellently put!
  5. by   traumaRUs
    Everyone knows that heparin and nitro are compatible. However, it is our hospital policy to hang both separately. So...simple answer..you follow the rules. You did great!
  6. by   *Peanut*Vennie*
    Im with the above poster, I thought you handled it great. Just because something is compatible, doesnt mean that you would feel comfortable hanging it. Good job!
  7. by   mittels
    For one thing, I didnt think you could have blood go through a picc line, I thought it would damage to many blood cells as it was pushed through. As for the abx and heparin, you did the right thing. it would give the pt a mass bolous if you were to let have the abx pump what was in the line prior to the abx.
  8. by   mayumi
    you did the right thing, yes, some drugs are compatible w/ each other but you have to take into consideration your hospital policy. good job!
    Quote from Sadie04
    The other day at work I had a patient admitted for an infected hip prosthesis; he had a revision and was on IV antibiotics post-op. His medical hx included a cardiac valve replacement, so he was on a heparin drip. There was a student nurse assigned to the patient; the nursing instructor works per diem on my unit. His crit was 25 so I was getting ready to hang some RBC's. He had a double lumen PICC with the heparin infusing through one port, and I was infusing the blood through the other port. I was explaining to the student the protocol for transfusion when the instructor came in and said to the student "are you ready to hang his antibiotic?" I gently reminded her of the hospital policy that heparin must run alone (we can't piggy-back anything with heparin, insulin, blood or albumin) but she said "I called the pharmacy and they said heparin and ceftriaxone are compatible." I didn't want to argue or cause a scene, but I didn't think it was appropriate to set that kind of example for the student! So I said "let's wait until after the blood is done." The instructor took down the antibiotic and left the room. I'm don't know if I handled the situation right...
  9. by   sharann
    I think you did right. The blood was the PRIORITY, then the AB could go up later. Then of course you must follow hospital policy. Good going!
  10. by   dphrn
    You did the right thing. You followed policy and in the end, it was YOUR patient...so you had the call. Good job.
  11. by   Tweety
    If you are sure it's the policy then go with the policy.

    Also remember it's an old nursing myth that heparin has no compatabilities, as long as the drip rate isn't affected by the piggyback there are things that can be hung with a heparin gtt, so you can't blame the instructor for trying.
  12. by   bluesky
    We just piggy-backed mag runs on an a-fib pt who was on a heparin drip just Tuesday... my preceptor Ok'd and hung both. That isn't appropriate?
  13. by   RNPATL
    Quote from bluesky
    We just piggy-backed mag runs on an a-fib pt who was on a heparin drip just Tuesday... my preceptor Ok'd and hung both. That isn't appropriate?
    Maybe I am from the old school, but I like leaving my heparin gtt independent of any other drips. Again, perhaps that is because that is the way I was taught when I was in nursing school. I agree that heparin is compatable with other drugs, but would not consider running it with ABT piggy backs or any other fluids or medications. Again, I think it is important that you review your facility's policy in relationship to heparin. Most facility's require that heparin infuse as a stand alone. At my facility, the policy says that heparin is not to be co-infused with any other fluids or medications.
  14. by   lisaloulou
    Quote from mittels
    For one thing, I didnt think you could have blood go through a picc line, I thought it would damage to many blood cells as it was pushed through. As for the abx and heparin, you did the right thing. it would give the pt a mass bolous if you were to let have the abx pump what was in the line prior to the abx.
    Regarding the PICC: I use 5F and 7F PICC lines, not only can you draw labs and infuse blood, you can monitor CVP if you like. The 5F double is approx. like 2 18G regular IVs and the 7F double is approx like 2 14G regular IVs. With optimal placement, those babies will ZOOM infuse if need be. The "old" PICCS are 3F and not much good for anything in my humble opinion.

    A well placed PICC is a work of art.

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