Central lines/ PICCs

i would wonder if running all 3 at maximum rate of infusion at the same time might send the pt into chf?

There wont be issues if there is nothing else running piggybacked into those you mentioned. Nothing should be run into the same port with blood, insulin gtts or TPN. Now once the blood is completed flush the line and hang your IVPB on that port. Normally the doctor is going to tell you what rate the TPN and/or IVF need to run. The blood should be run fairly slowly if you have TPN and fluids going. And of course monitor your patient for fluid overload if they have history of CHF or other renal problems.

If your patient is in a condition that all 3 must run full speed, then that patient needs to be in ICU where they have one on one care and can be monitored more closely.

I would be paranoid about the possibility of fluid overload. If it were me I would have gotten an order to give Lasix.

Depends on the underlying diagnosis of the patient. Not everyone develops CHF.

Also depends on the rates being infused. If you had TPN at 40ml/hr, insulin at 2 ml/hr, and blood at 75ml/hr I wouldn't worry about fluid overload (depending on pt diagnosis of course).

As to the OP's question - you can generally run incompatible things on separate ports of the central line, but not all on one port. So I wouldn't mix blood and something else on the same port, but that's why you get 3 or 4!

The TPN port should be reserved solely for TPN.

BTW, This should not come up on a med/surg floor, but there is a drug, Adenosine, that is given via PIV only. (Not that it hasn't been given via central line...)

The PICC line is set up so that the different ports come out at differnet lengths at the end of the line. So the items that are in different ports dont' actually mix before entering the blood stream.

The PICC lines I am used to using are the purple power PICCs and they only have two ports on them, so I guess I would have to get a separate PIV for one of the fluids you mentioned. But if you had three ports to work with then theoretically you could do all three at once being mindful of the total amount of fluids given.

You could run the Insulin into the tpn..

I always decrease the iv fluids by what the blood is running at. Unless im very positive the patient can handle the volume and not go into CHF. Even with potassium in the iv fluids the 3-4 hours that the rate is decreased isnt going to change the level that much unless your patient is very hypokalemic. Usually the K+ is going to be in the TPN instead anyway. Nothing should run into any of the fluids you mentioned, and yes i would wait to run any IVPB's until the blood is completed, you can run the IVPB between units is you have to hang more than one unit.

This patient sounds like a little more than should be on a normal med/surg floor anyway if they need insulin gtts they need hourly blood sugars and thats more than i know we can do with our patient loads. That, and with blood and TPN?,, Id be asking about sending this patient to the units anyway, they dont sound stable at all.