Chemotherapy/blood transfusion via PICC

[Lonestar RN]

Is it safe to administer chemotherapy and transfuse PRBC/blood products via 2 lumen PICC line? I was caring for a patient one night who was on a continuous cytarabine infusion x 7 days, and was having to receive PRBC/plts fairly frequently. Additional peripheral line was established on opposite arm to allow for IV antibiotics/transfusions. I transfused plts on the peripheral line since "you can not run anything with chemo infusion" (as I was taught by my preceptor). However, when I returned the next night, the AM shift nurse had both the chemo and PRBC infusion going to that 2lumen PICC, and IV vanco on the peripheral. His response was that "well, _____ (clinical supervisor) said it was okay" because one of the oncology MDs had once told her that it was fine to do so. I asked other nurses on the unit (med/surg/oncology) and they were not sure. I attended a chemo provider course and was "checked off" for chemo administration by the senior "chemo nurses" before I was able to start chemo administration but that was it, and I'm pretty new to the whole oncology/chemo world. Any info would be greatly appreciated.

[SoldierNurse22, BSN, RN]

We had this debate on my floor once, too. We had a patient who was on a continuous chemo infusion much like the patient in your scenario who needed blood. They had absolutely zero peripheral veins. After many attempts to establish another site, our CNS came in and told us we were wasting our time as it was perfectly safe to run chemo and blood and whatever else you might need at the same time via different PICC lines. For the same reason you can run TPN and an antibiotic on two lines of a PICC, you can also run chemo and blood--they're not going to mix in the process of infusing.

Our concern, of course, was if the patient had a reaction to the chemo or the blood, how would you know which one was causing the reaction? However, this patient was ill enough that if they didn't receive the blood, we were going to have to stop chemo, so in the end, we infused both and everything turned out fine.

I don't recall the exact information our CNS provided at the time to prove the safety of such a procedure, but the following is from a quick Google search:

http://www.plymouthhospitals.nhs.uk/ourservices/clinicaldepartments/Documents/PHNT%20CVAD%20Guidelines%20%20November_%202011.pdf

Non-tunnelled CVC's may have single or multiple lumens. Each lumen provides independent access to the venous circulation so that incompatible drugs/fluids may be administered simultaneously.

[wooh, BSN, RN]

Different lumens are different lines for the sake of compatibility, etc. If you can run it through two different IV sites at the same time, you can run it through two different lumens at the same time.

[OCNRN63, RN]

Agree with what SoldierNurse said. If I have time later I'll see if I can find any info in the Core Curriculum or the handbook for the Chemotherapy/Biotherapy course.

[cancer.sucks]

I also agre with what SoldierNurse said. The one coment that i would add is that if the chemotherapy and blood will both be running simultaneously, best practice would be for the chemotherapy to be running prior to the blood infusion. If the chemotherapy is infusing continuously over a number of days and the patient is intermittently receiving transfusions or antibiotics for that matter. You would not want to start both of them at the same time. If the chemotherapy has been hanging for a couple of hours without any reaction, the likelihood of the chemotherapy causing a hypersensitivity reaction at that time is quite low.

[iluvivt, BSN, RN]

Yes you may. It is one tube but it is split down the middle all the way to the distal end so that both infusions will exit in the SVC with a very high blood flow rate providing excellent hemodilution. It would have been best vein wise to administer the chemotherapy and the Vancomycin via the PICC and given the blood via the PIV. The Vancomycin is very aciditic and is more apt to cause a phlebitis and infiltration than blood. Blood and blood products can be administered through a PICC as well but since it it so viscous it may have been easier to administer through the short PIV. It is not incorrect what he did it is just the Vancomycin is more irritating and you always want to give the most irritating medications through a central line if you have one. I had a nurse recently give Calcium Chloride through a PIV when she had a perfectly good central line..yikes...yeah it extravasated..I treated it but it still blistered some! You always need to know what you are giving and look up the ph and osmolarity if you are using both PIVs and CVCs so you can select the best options and set up.

[globalRN]

Vancomycin is also an antibiotic that we try not to run peripherally,(damages veins). Since you have a PICC, I'd use that.

Was it not possible to run everything through the PICC lumens? One would be running cytarabine. Can the second lumen not

be used for all the rest...just schedule everything?

[NelletheNurse, ADN, BSN, MSN, APRN, NP]

ongoing debate in my previous facilities....all opinions are valid. docs I've asked would say to go ahead and give blood at same time in instance of continuous chemo. chemo wouldn't be stopped, as the transfusion will take hours. the only issue I hear from all nurses is "how will we know what is causing the reaction, if pt reacts"...and the above response to that is valid.

[_Skittles_]

In my facility we would run both through the picc. If there was a reaction to the cytarabine we would continue anyways with the chemo because it's necessary and just give IV meds for sensitivity

[Gooselady, BSN, RN]

This was a debate on our unit too, and you'd walk in at change of shift and find nurses doing it differently and having good reasons for it. So I had to think about it. Each lumen is a separate access, it's going in a huge vein with high turbulence, so you could ostensibly put anything in either lumen and be fine. Theoretically, anyway.

If the Cytarabine is continuous, you likely have a 'baseline' of the patient's response to it. Hanging a unit of blood adds a risk for ANOTHER reaction, which you wouldn't want confused with a reaction to whatever else is infusing. With Cytarabine, like I said, you have the baseline so any funny stuff with the patient is likely due to the blood. The point is to not hang two risky infusions at the same time, cuz if the patient reacted, how would you know what he was reacting to? In your situation, this wouldn't be an issue.

Since most patients getting Cytarabine et al are going to need transfusions, and most of them had double lumen PICCs, I'd get a peripheral IV put in for the blood/platelets because you KNOW that second PICC lumen is gonna have Vanco or some other irritant antibiotic needing to infuse through it. Blood is, well, blood, even the small peripheral veins love blood, so use your peripherals for blood products and save the other lumen for nasties like Vanco or Unasyn or whatever.