FFP with diprivan?

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.

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.

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.

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.

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.

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.

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!!

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.

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!

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 :)

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...

Diprivan and FFP (blood products) should never run together in a peripheral line. A central line cath/ or cordis is the standard practice when administering these two products. Preferably, two central lines should be saved, one only for Diprivan and one only for all blood products. In a trauma/ critical situation where you have only a peripheral line, I would use the peripheral line only for FFP, and start another peripheral line or two on the other extremity at the antecubital region using a 16 g or 20 guage needle.

The primary reason for the central line is to have a line in a large vein where you have more control of the med, and to prevent burning/infiltration of a small peripheral vein. With a central line, you can also stop the med/ blood product quickly and take action if a reaction were to occur and fluid resuscitate the patient if the blood pressure gets too low. Having a central line close to the heart in case you need to give fluid/ Levophed isn't a bad idea either .

Another reason not to use a peripheral line for blood products (includes FFP) and Diprivan has a high potential for fast bacteria growth from both of these products. Diprivan is a high lipid solution, where standards of practice dictate total line changes every 12 hrs. Blood products, too, can cultivate bacteria at fast rate, hence, the practice of not keeping blood products/lines up for more than 4 hrs. If you were to combine these two products in a peripheral line, it would be difficult to pinpoint the source of contamination if you were to culture the line.

If the patient is trauma patient or sick enough to need FFP/blood or Diprivan for continuous intubation, or a surgical procedure, and you can't get a central line/ cordis /PA cath in I would definitely call the next surgeon on call to get a central line in asap.

In some ICUs, the tendency is to hold off inserting central lines to prevent sepsis down the road. If you feel more I.V. drips are being added on by the hour , or your patient is in critical and unstable condition , I would persevere in asking for central lines.