FFP with diprivan?

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I was wondering if anyone has ever given FFP with diprivan before? I had a pt with 1 peripheral and needed to be sedated with diprivan, but also really needed FFP and we were unable to get another peripheral or central (for various reasons). I was told I could run them together, and did, but was wondering if anyone has experience with this? I thought you couldn't give anything with blood products except NS, but was told FFP was different?? And very few things can run with diprivan. Anyone??

Specializes in ICU, PACU,TRAUMA, SICU.

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.

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Specializes in Critical Care, ER.

Another option if you are having that much trouble & need it emergently is I/O access. Our ER keeps an IO kit available and the ER docs will come up & help us out if needed. I've only had to do this once but it's soooooo good to know it's available when you need it!

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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!!

Right on, Neo! What if the pt's BP tanked? Somewhat likely with propofol . . . are you just going to keep juggling with one IV? If you have to, use intraosseous access! Oh, I didn't see the previous post!!

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Central lines should be a prerequisite for ICU admission. We run into problems with this in the MICU when we need to start pressors NOW or the patient's line (gets pulled out) has a mishap, and the medicine resident stands in the doorway ringing his hands telling me he is not certified, he will have to call the chief to watch him, and meanwhile the pt is dying because no one can get in a new peripheral.....

I would have done what someone suggested, given a heafty dose of versed and fentanyl iv push, run in the ffp and then restrated the propofol. If they NEEDED all that stuff, they certainly should have had a line. I hope that surgery the doc was doing was really important.

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Specializes in Critical Care, Progressive Care.
Another option if you are having that much trouble & need it emergently is I/O access. !

Yeah! There is a growing body of lit that supports the use of IO lines. Some anesthesia residents I know put them into eahc other. They assured me they do not hurt going in, but infusions and be a little painful. Have you seen the nail gun they use to do it? Totally rad. Paramedics use them all the time now. They are becoming more common in the ED. I suspect they will be readily available in the ICU.

I am curious. If the pt needed propofol and FFP and was vented we can assume she is fairly unstable and might possibly need more than that on 20g in her mamary. And if the lin- meisters in anesthesia could not get a line into her why didn't somebody think she might need a central line? If I were the pt I I would want a central line, like in case I got septic or something after my surgery and needed a little fluid....

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Specializes in OR, peds, PALS, ICU, camp, school.

WHY was is so hard to get an IV or line in this pt? BP issue? already clamped down?

I agree with the IO. Sounds like you're in a small hospital? If the ER didn't have them, I'd be calling the local EMS to see if they could lend one out. This pt needs access. What if she pulled out the only line you had?

If a CVL was attempted and not successful and you can't get your hands on an IO, maybe it's time to pull out the old cutdown technique.

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If a CVL was attempted and not successful and you can't get your hands on an IO, maybe it's time to pull out the old cutdown technique.

What do you mean by "cutdown technique"?

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What do you mean by "cutdown technique"?

create sterile field, local anesthetic, scalpel, incision through skin and fascia, find vein, cannulate, close up

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Specializes in OR, peds, PALS, ICU, camp, school.
What do you mean by "cutdown technique"?

Of course the problem here is getting that Doc out of the OR or getting someone else to cannulate.

Like the PP said, a surgical (at the bedside) incision is made, vein lifted, often tied and ligated distally, and the proximal section cannulated and ligated around the cannula.

Site selection is very specific. Often they are placed in the saphenous vein but I believe a venous cutdown can be performed at the femoral vein with a CVL placed using a standard seldinger technique. I believe in that case the vein is not ligated. Anyone know?

Cut-downs were seen much more often prior to IO use. They used to be covered in PALS and, if I remember correctly, ACLS but I don't think they have been since everything was simplified.

Not long ago I had a pt with an old medial ankle scar that must have been from a cut-down. The other nurse in the room had never heard of it either when I mentioned it. It surprised me, but it makes sense that it's fallen off the radar. But still, doctors usually know when it needs to be done and how to do it.

Also, I worry that the pt mentioned in the OP may have been septic and experiencing some vascular collapse, sepsis? No way to really tell with the info we have. But I'd push to start abx right away even if we need to choose IM preparations.

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