Can you give blood and antibiotics both at the same time through a triple lumen cath?

hypocaffeinemia, BSN, RN · Nov 16, 2008

Yes, you can access it via different ports. However, I wouldn't give the first dose of a new antibiotic at the same time as blood, as you would have difficulties determining the source of any potential reactions.

I'm also a nursing student, but this is what they taught us in our central line lab.

RN1982 · Nov 16, 2008

I agree.

Tweety, BSN, RN · Nov 16, 2008

I agree; it is also a good point about monitoring for a reaction.

Blood moves through the body relatively quickly; the heart pumps 60 to 100 beats per minute, over a gallon a minute. So use those lumens; that's what they are there for.

BinkieRN, BSN, RN · Nov 16, 2008

It is done all the time. I agree about starting a new med or the first dose of an antibiotic when starting the blood because if there is a reaction, you won't know if it's the blood or the med causing it and would have to stop both at least temporarily.

mpccrn, BSN, RN · Nov 16, 2008

Ditto.

BookwormRN · Nov 16, 2008

Agree about giving new med and blood simultaneously; otherwise, yes-you can give antibiotics and blood simultaneously through a triple lumen.

That is why they are placed!

Magsulfate, BSN, RN · Nov 28, 2008

If there is a blood transfusion reaction, it will most likely be within the first 15 minutes of the transfusion. Given that information, you could always wait 30 minutes to an hour after starting the blood before giving the ABX. If it is a new ABX and the patient has never had it, I might wait a little longer unless your hospital has a policy against it. Check that out. If not, then use your nursing judgment. You also want to ensure you're not giving the person too many fluids at once and putting them into fluid overload. That most likely wouldn't happen because the patient is already anemic anyway. But you have to consider everything.

chani · Nov 30, 2008

You can give blood and AB through different lumens of the central line at the same time. However, a CVC is not the most appropriate way of delivering blood because it's long and skinny. I am not sure I agree to wait regarding the new AB with the first dose because the reaction will likely be the subsequent dose as the patient will need to be sensitized. Unless, of course, they have had the same class of drugs and developed a sensitivity. It will be all muddled up anyway.

My rule is always to give AB on time because of the need to ensure an appropriate blood level to kill organisms. So I guess I would need to understand the context for individual patients and ensure it fits them.

hypocaffeinemia, BSN, RN · Nov 30, 2008

chani said:

You can give blood and AB through different lumens of the central line at the same time. However, a CVC is not the most appropriate way of delivering blood because it's long and skinny. I am not sure I agree to wait regarding the new AB with the first dose because the reaction will likely be the subsequent dose as the patient will need to be sensitized. Unless, of course, they have had the same class of drugs and developed a sensitivity. It will be all muddled up anyway.

My rule is always to give AB on time to ensure an appropriate blood level to kill organisms. So I guess I would need to understand the context for individual patients and ensure it fits them.

A CVC's lumen isn't any smaller than a peripheral IV and is often more expansive. For instance, the distal ports are 16 gauge at my hospital, and it is long, but nothing is contraindicating using a CVC for blood administration.

Regarding allergy formation, you'd go slow with the first dose precisely because they'd been sensitized to it in the past. Even if it were a new antigen, there wouldn't be much of a problem with the second dose as your body doesn't turn around and make antibodies that fast. Now, third or later doses, sure, which is why we must always be vigilant.

chani · Nov 30, 2008

You are correct that a CVC can deliver blood and that most lumens are wide. However, they are also a whole lot longer than a peripheral IV, and if you want to give the blood quickly, then it will be slowed down (poiselles law )allnurses.com/forums/f16/radius-4th-power-76225.html

So that's why I said it depends on the context. For critically ill patients with multiple IV and lots of meds, a peripheral cannula is often better logistically as you can run the blood without worrying about getting other meds in. If they need the blood quickly, you can get it in quicker.

Magsulfate, BSN, RN · Nov 30, 2008

I have never considered that Central lines are 'longer' a bad thing regarding blood administration. In a critical care setting, I think the central line will be the BEST route of any IV medication. Most critical patients I've had, have little or no veins to speak of, and putting in a peripheral line to administer blood has never crossed my mind.

The only issue with administering blood and ABX simultaneously would be a reaction and the problem of solving WHICH drug (or blood) is causing the reaction. So, if you know this patient has had the ABX before and has not had a response, go for it. As a previous poster said, the ABX (especially the first dose) must be given asap to start treatment for the infection process.

However, the blood needs to be given asap too. Both need to be delivered, but you must use your nursing judgment to tell yourself which one should start first. You can't begin them both simultaneously if it is the first dose of a new ABX.

So, if there's no policy on it, I would wait around 30 minutes after the blood starts transfusing because that's when you're going to get a reaction to blood IF you're going to get it.