Administering blood w/meds via PICC

[IngyRN]

Hi All,

There was quite a heated discussion at work and was wondering what you guys have seen in your experience. Can you transfuse PRBC thru a double lumen PICC through one port and meds thru the other simultaneously?

One argument is that since a PICC is a central line-it can be treated as such. And as you could do this thru the distal port of a triple lumen central line same should be true of the PICC.

The other side argued that although a PICC is a central line, it is unkown which is the distal port and blood transfusion may mix w/med.

Your 2 cents is appreciated.

Thanks!

[Kymmi]

Yes...you can adminster blood thru one port and meds thru another port on a double lumen picc line.

[IngyRN]

This is what I thought. However, does it matter which port? Is this a policy in your facility is there some literature ( ie manufactorer's ) ? Thanks again

[UM Review RN, ASN, RN]

I think you'd want to use the largest port for the blood, considering that RBCs are pretty large.

I think also, since you need a 4 or 5 French or larger in order to use it for blood draws, so you might need that size to transfuse blood.

Best to check your hospital's policy. :)

[Diary/Dairy, RN]

I am with the other posters - why would you not admininster meds and PRBC;s through a PICC's different ports at the same time??

[Diana,RN]

Unless the med is uncompatible we give it if necessary. I would definitely pull P+P on this one.

Diana

[Roy Fokker, BSN, RN]

it is unkown which is the distal port

Huh??? The ports are always marked - and they show catheter guage size too! :)

Example of a PICC line: LINK

[CritterLover, BSN, RN]

originally posted by ingyrn

it is unkown which is the distal port

huh??? the ports are always marked - and they show catheter guage size too! :)

example of a picc line: link

some piccs don't have a "distal" port.

the ones i place are trimmed, and thus both ports are flush with each other, rather than staggered.

doesn't matter as far as infusing incompatable substances are concerned, though. that is the whole point (almost) of having a double lumen. if you coulnd't infuse incompatable substances at the same time (through different ports), then you might as well only have single lumens, and infuse them all through the same port.

so, to answer the op's question: it is perfectly ok to infuse blood and another substance through different ports of a picc at the same. time.

it doesn't matter which is the distal port. the tip of a picc is in the svc. blood flow there is very fast, and meds/infused substances are quickly diluted.

[Daytonite, BSN, RN]

One of the reasons for inserting a dual lumen PICC is for the purpose of infusing two different solutions (including a blood and blood products) through each line at the same time. The answer to the question at hand ultimately lies in where the tip of the PICC line rests. Usually, it is in the superior vena cava of the heart. This can be confirmed by looking at the x-ray report because the placement of the catheter tip should have been confirmed by x-ray. The turbulence of the blood in that anatomical area makes the idea of any solutions getting intermingled moot. The minute any infused solution exits the PICC it enters the turbulent blood flow of the superior vena cava and is instantaneously mixed with the incoming blood flow going into the right atrium of the heart and is hemodiluted.

Most PICC lines have one lumen that is slightly larger than the other. They are usually marked in some way. There is also a booklet that accompanies each PICC insertion kit. This booklet is usually placed in the chart at the time of insertion (at least that's where we put it). It has information about the catheter in it. You might contact your central supply people or the personnel who insert these PICC lines and ask if they have any information about them that they can share with you. The manufacturers also have a lot of information about the lines that your hospital purchases from them. You merely have to contact the representative who sells them to the hospital. They are usually very accommodating and will supply educational materials to the staff. You will probably find, however, that someone in the hospital has already obtained this information. Your job is to figure out who and get copies of it from them!

[Roy Fokker, BSN, RN]

some piccs don't have a "distal" port.

the ones i place are trimmed, and thus both ports are flush with each other, rather than staggered.

wow! had no idea.

learn something new everyday. :)

thanks!

[IngyRN]

Thank you all for your replies. I will look into the P&P. Instead I asked the unit manager as well as the Head of Nursing Education, both who said "absolutely cannot" administer anything simultaneoulsy w/blood regardless of access. The only time this is an exception is during an emergency thru a triple lumen through the distal port. I will do some research and show them some data. Thanks again.

[Kymmi]

You cannot adminster anything thru the SAME port of a double lumen PICC with blood....but you CAN adminster blood in one port and a med in another port. Ask the nursing educator or whoever you asked what you are supposed to do if you have no access other than the PICC and you can't get a peripheral line and you have to give blood however the patient is also on heparin or levophed or cardizem...or pick any other drug that you could not shut off for a few hours while you infuse the blood. I wont go into the route of the PICC because so many people have done a great job of explaining it already but that is the purpose of duel lumen port. Nothing else is supposed to be run with TPN but do you run the TPN in one port of a duel lumen PICC and then your meds thru the other?? I know I do.