FFP with diprivan?

kristenallene40 · Apr 3, 2009

I haven't actually given it together, but IV Med book by Gahart 2003 says Diprovan is incompatible with all blood products including plasma and not to admin though the same IV cath. I guess under life saving emergencies it would be ok. FFP's rate is very fast and tranfuses over like 15 min. So unless the patient was very roudy and pulling all lines out, I would prob infuse diprovan for a few min until sedation, bolus with diprovan, flush line, then transfuse FFP quickly, then bolus again with diprovan to reinstate sedation.

photomom · Apr 3, 2009

Hmm... Good to know for next time! I wonder why that is?

Unfortunately, she would not have made it 15 mins without sedation - at least not pleasantly and with ETT in place - as we had toyed with that idea.

caroladybelle, BSN, RN · Apr 3, 2009

As far as I know, blood products should not be given with anything but NS.

Not applicable to FFP, but do know of a few cases of nurses running RBCs with fluids other than NS, resulting in cell hemolysis and they had severe reactions to it.

kristenallene40 · Apr 3, 2009

Diprovan is so tricky but so good for sedation...some people will be knocked out within a minute and stay that way, but others will fight until you have a very high dose going in...I've seen it especially in an overdose situation after she started to wake up and fighting the ETT. Took several boluses of Dip before sedation was effective.

meandragonbrett · Apr 3, 2009

Next time....talk with your physician and see if you can nebulize 4mg of morphine and 4mg of versed before you turn the propofol off to give the FFP. Or you could give it IV and give the FFP quickly after that.

photomom · Apr 4, 2009

again, good idea. I think the most frustrating part of it was that the physician wasn't willing to be involved in the solution. He was in surgery all night and wouldn't even really talk to me (except through the OR nurse to tell me to place another peripheral which was not at all possible when anesthesia had even tried a bunch of times peripherally and a central femoral) but just expected it to somehow work itself out.

It was also the first time I had ever given FFP and I don't think I realized how quickly it could go it since I was only used to giving PRBCs, so I was thinking there was no way I could keep her sedated enough for that long.

NeosynephRN · Apr 4, 2009

If she was on a vent and sedated with diprivan with only one PIV..how were you giving all her antibiotics and other meds?? Man that makes me crazy! You already got some great advice here...but just in agreement that one IV is NEVER enough!!

photomom · Apr 4, 2009

Well, she had just been admitted at shift change, and her antibiotics were being held until morning when hopefully we'd have another line in place. Yeah, we needed more access.

GucciRN22 · Apr 4, 2009

i hate it when pts come to the unit with no central lines or only one iv from the er when there are the people there who can put those lines in. especially in cases where the patient is really needing the extra lines! i'm sure there's a reason for it, but it sure is frustrating!

labcat01, BSN, RN · Apr 5, 2009

gah...I always say that my least favorite patients are the ones with poor IV access. I can handle ANYTHING else but that :)

Oh and great advice in this thread! I'm so glad you asked about it :)

photomom · Apr 5, 2009

Yes, it drives me absolutely bonkers. Recently I had a pt with orders for blood and she had a 20 in her boob... uhm, not the best access?? And I don't think there is a good reason that they don't come up with appropriate IV access when there are orders that require that access. In my case with the diprivan pt, however, anesthesia DID come up and try to place a line (unsuccessfully) so I don't think they would have had success had they tried in ED, either. But it's just even more mind-boggling on night shift because we already don't have the resources we need - and when they don't put piccs in on the weekends that limits us again. Unfortunately, I don't see it getting any better in the near future, either...