PICC line or Port a Cath & Running Blood

MunoRN, RN · Jul 16, 2014

I wouldn't worry about exceeding the maximum rate the PICC can handle, typically PICC lines can handle 300ml per minute of flow.

As for holding other fluids that depends. It depends on the protocols and the collaborative relationship between the nurses and the physicians. It's not unusual in an ICU setting for nurses to adjust maintenance fluid rates based on a list of variables, although this falls under something that's done in collaboration with the Physician even if there aren't specific orders. On a floor, absent a protocol that says to hold IVF, you would need to discuss holding fluids during transfusion with the provider.

nurse2033, MSN, RN · Jul 16, 2014

Yes it is safe in a multi lumen line, the fluids won't mix in the line. I don't know of any reason you couldn't give blood through a portacath, but have never done it. You need orders or a protocol to adjust the rate of fluids.

0.adamantite · Jul 16, 2014

I'm not worried about exceeding the rate the PICC can handle, but many of our patients are at risk for fluid overload and I wouldn't want them running at 300 ml/hr for 3 hours. I've been told that it's safe to run even incompatible solutions through different lumens of the PICC because of the high rate of blood flow where the PICC ends helps prevent mixing of the drugs.

MunoRN, RN · Jul 16, 2014

No, you don't need to worry about incompatibilities with different lumens. Fluid overload definitely can be an issue, although sometimes they need all the volume they can get, but usually I hold maintenance fluids while blood is transfusing, and I restart them after the transfusion based on the patient, but then again I'm a rogue nurse I can't suggest following my lead, ask the Doc.

IVRUS, BSN, RN · Jul 16, 2014

I too wouldn't worry about this flow rate for the PICC as it can handle that flow rate without difficulty, I would, however, worry about fluid overload. How old is the pt? Does he/she have a comprimised cardio-pulmonary or renal system? I would NOT change the prescribed rate of the TPN, but, the blood must be infused within 4 hours.. so a 250 ml blood bag can be given at 63cc/hr if needed. The lab should be able to weigh the bag if the volume isn't on the blood bag itself. And yes, blood can be safely given in an implanted port.

Now, if this is too much fluid for the patient to handle, get the MD involved and get specific orders for their administration.

MissM.RN, BSN, RN · Jul 16, 2014

Good questions OP. we always need to be thinking about overload and incompatible meds, but in this case i'm guessing the patient needs volume repletion asap. do the math, find out how much total volume is going in each hour, and I always think about worst case scenario like flash pulm edema.

yes, you can do a blood transfusion through a port (port o cath, IVAD, chest port, whatever you want to call it :) ). I have, and with my patient population, it may be near impossible to get a 20G or larger bore IV anyway. i would look in the chart to find out what type of port it is (power inject, heparinize, etc) and flush according to the manufacturer's requirements. i believe almost all ports and piccs need to be flushed with at least 20cc of NS after things like blood, TPN, and vanco.

multi lumen picc's are great, you can do your TPN/lipids, blood, and meds all through it. utilize your pharmacist as a resource too. if you're ever unsure about your line/incompatibilities, just give them a call. you always have the hospital's policy manual too.

iluvivt, BSN, RN · Jul 20, 2014

Yes I agree with many. I do find that the pharmacists are great at providing information about incompatibility information are not savvy about CVC line design and nursing protocols. If you have a PICC nurse or IV nurse you can consult them as well. As far as flushing protocols go you need to follow your institution's policies since technique may vary a bit depending upon the needless connector you are using of the 3 types. Each IV system including the catheter must be cared for as a whole.As far as flushing volumes the flush need to be at least 2 time the priming volume of the VAD plus the volume of any add on devices. Many policies will double the volume after a blood draw,blood draw check or blood administration.