IV scenario

Published

Anybody interested in helping with scenario question? The patient has a central line with TPN infusing at 75cc/hr. Intralipids are infusing int the second lumen and blood is infusing into the third lumen. You have an order to infuse Gentamycin 80 mg IVPB and Vancomycin 500 mg IVPB, both at 08:00 AM. What would you do? Thank you to all that reply:idea:

Up Vote Up Vote ×
Specializes in Education, Acute, Med/Surg, Tele, etc.

WOW...great question! I am just getting into this type of scenero now (been a nurse 6 years but getting back into med/surge and ortho...never dealt with this!).

So I will take a stab on my own thoughts here...but actually I would be asking my charge nurse...LOL!

I would find out if the person could get another line started in the arm and go that waywith the antibiotics???...even though I believe those antibiotics are preferred to go CL because they are harsh. SO run a line of NS...IVP via that at the right rate of push (separately with long flushes!!!). Remember I am just taking a stab at this...I would be asking for assistance.

Also, can't the lipids be given with TPN in the same line as long as the TPN is filtered and the lipids are below the filter??? That would free up one port. And I believe TPN/Lipids can be stopped for a time to infuse antibiotics (good flush before!).

Hopefully I am not too far off??? LOL!

Up Vote Up Vote ×
Specializes in Adult ER.
anybody interested in helping with scenario question? the patient has a central line with tpn infusing at 75cc/hr. intralipids are infusing int the second lumen and blood is infusing into the third lumen. you have an order to infuse gentamycin 80 mg ivpb and vancomycin 500 mg ivpb, both at 08:00 am. what would you do? thank you to all that reply:idea:

i'm a new nurse (just finished :))but i would have a few questions first ....... how much longer will the blood be infusing for......... does the patient have any allergies to either of the meds or have they had the meds before i'm only asking this cause if the patient is receiving blood your still monitoring for reactions right?? are the antibiotics a one time dose or will they be given bid/tid.

if it was a stat and everything was going well with the blood i would stop the tpn/intralipids (never had to give both seperatly before as i believe that in my hospital they are together in the same bag..... but i am assuming here that they go together) run ns and give the meds by iv push (with flushes of course) over the set time. but honestly since i am so new i would ask my charge nurse if this was possible to do or what would be the better route to go as i may be wayyyyyyyyy off the mark lol

Up Vote Up Vote ×
Specializes in Critical Care, Emergency, Education, Informatics.

Retime the Vanc and Gent first of all. Ask for a dedicated TPN line.

Up Vote Up Vote ×

Infuse the tpn and lipids, same line. Only if ok per policy.

Up Vote Up Vote ×

I would temporarily stop TPN and lipid, flush each port with 10cc NS, administer antibiotics

Up Vote Up Vote ×
Specializes in Med-Surg, Wound Care.
Retime the Vanc and Gent first of all. Ask for a dedicated TPN line.

I'm with this answer. This patient is already getting enough fluid at one time to consider adding more. For the sake of two hours for the blood to infuse, I'd retime the antibiotics.

Up Vote Up Vote ×
Specializes in Surgical.

Wow, please don't stop TPN. Ok, assuming this is a triple lumen CVL (why do they make any less) I would run TPN and lipids in one port together and dedicate this line for TPN. The second port for abx and the third for blood products. Unless there was an urgent need for abx asap then wait for blood to transfuse.

Up Vote Up Vote ×
Specializes in Utilization Management.

I'd call the Pharmacy for input about whether we could run the TPN/lipids together, as mentioned by Triage. I would not stop the TPN, nor would I use the TPN line for anything else.

If Pharmacy wasn't available, I wouldn't guess.

I might run the blood over a couple of hours, then run the antibiotics afterward through the same lumen.

I like the peripheral line idea also, but I'd probably transfer the blood line to the peripheral and run the antibiotics in the central line.

So let us know what the answer is, please, because now I'm really interested in finding out.

And Danigirl, I don't know about how it works in Canada, but I don't think we're allowed to give those antibiotics by IV push. Especially Vanco, because if Vanco runs too fast, the patient can have a reaction called "Redman Syndrome." So Gent and Vanco are infused.

Up Vote Up Vote ×
Wow, please don't stop TPN. Ok, assuming this is a triple lumen CVL (why do they make any less) I would run TPN and lipids in one port together and dedicate this line for TPN. The second port for abx and the third for blood products. Unless there was an urgent need for abx asap then wait for blood to transfuse.

Why bother...the antibiotics will only be run over half hour probably. There should be plenty of residual left in stomach to cover that short time. I say just stop TPN, for the half hour then resume after antibiotics have run. If not sure how much is in stomach just do a quick check for residual.

Up Vote Up Vote ×
WOW...great question! I am just getting into this type of scenero now (been a nurse 6 years but getting back into med/surge and ortho...never dealt with this!).

So I will take a stab on my own thoughts here...but actually I would be asking my charge nurse...LOL!

I would find out if the person could get another line started in the arm and go that waywith the antibiotics???...even though I believe those antibiotics are preferred to go CL because they are harsh. SO run a line of NS...IVP via that at the right rate of push (separately with long flushes!!!). Remember I am just taking a stab at this...I would be asking for assistance.

Also, can't the lipids be given with TPN in the same line as long as the TPN is filtered and the lipids are below the filter??? That would free up one port. And I believe TPN/Lipids can be stopped for a time to infuse antibiotics (good flush before!).

Hopefully I am not too far off??? LOL!

:yeahthat: :yeahthat: :yeahthat: :yeahthat: :yeahthat:

Up Vote Up Vote ×
Why bother...the antibiotics will only be run over half hour probably. There should be plenty of residual left in stomach to cover that short time. I say just stop TPN, for the half hour then resume after antibiotics have run. If not sure how much is in stomach just do a quick check for residual.

you can't stop tpn, the pts sugar could drop. you could pb the lipids, as per protocol. vanco has to infuse OVER AN HOUR... it is the one that causes the red man syndrome. the problem is worse if there are vanco and gent levels due after the doses!:uhoh21:

vanco is usually once a day or bid.

*i* would put a peripheral line in, and if i could, an 18 or at least a 20, and run the blood there. i would flush the tlc and infuse gent first over 30 minutes. then flush again and infuse the vanco over an hour (on a pump) and retime the vanco. if it's only once a day, an hour off is the least disturbing. *IF* a vanco peak was due, i'd retime that for the next dose and note that it was given an hour later today bc of a blood transfusion.

Up Vote Up Vote ×
+ Join the Discussion