Prioritizing infusions

[sistrmoon]

Let's say you have a patient with a wound MRSA infection who also has low platelets(7). You have one hour left in your shift. Platelets are ready but if you hang them, antibiotic will be late. Pt only has one peripheral and is a difficult stick refusing further access attempts. Which do you hang? Two of my experienced coworkers disagree.

[Nurse SMS, MSN, RN]

Honestly? To me that just sounds like a whole lot of reasonable, understandable "Not my problem, here ya go day shift". If the patient throws fits about being awakened and the order came in that late, I don't see how you could be accountable for getting it done.

[Kate13]

I'm in the minority here, but I would hang the vanc. But I work in oncology, where 7,000 platelets and no active bleeding is not so alarming. There are hospitals where that's the transfusion parameter. If the situation changes, pause the infusion and slam the platelets (vanc may well be done by the time the platelets are in your hands).

[sgnemo25]

I would hang the platelets first of course. Low platelet count could lead to bleeding which takes priority over treating an infection. Plus it's better to infuse the platelets prior to the antibiotic which may also be the cause of the thrombocytopenia.

[Isis Phoenix]

From the information you provided,the platelet should be infused first,then the antibiotic after; as long as the platelet is on the unit ...that's the done thing,after the platelet has been infused...the antibiotic can be hanged,and depending on the amount,and the time ordered for infusion..endorsed the information to the nurse who will relieve you.

[ScudderRN31]

Did I also add this patient hates to be woken early to the point she had a sign on the door don't wake til 6? Yeah, it's the perfect storm of fun. And before you say "too bad," these are long term patients we have for months and they do complain about being woken early to our manager and then we are told not to do it. It's happened several times.

Vanco is due at 6.

Long term patient or not..there is nursing judgment that you must go by or may one day find yourself in a very ugly situation. This patient doesn't want to be woke until 6, you are questioning which action to take regarding their care and to avoid upsetting the patient and your manager...best thing I can tell you is cover your tail. Run it by the MD and get "approval" to document that either or may be late due to circumstances. If you don't and the patient has complications of any kind, it's you on the chopping block..not the patient and rarely the manger. Your license, your judgement. I have experience with long term care and I understand their rights but when it boils down to it some people will take full opportunity to throw you under the bus when it's given. Long term residents also have "a right to fall" to avoid restraints and so forth but how many lawsuits do you see regarding falls in long term care (or acute for that matter), and they win. May seem like I'm going on and on about it but I've seen it happen personally and have had to go to court to testify my findings of a patient when I came on shift, hated every minute of it especially since it was against a co-worker but that's part of nursing duty. I'd much rather have a patient upset with me and a valid argument with my manager if it means I'm taking proper care of a patient.

[sistrmoon, BSN, RN]

Even with patients like that, I'm entering the room several times a night and peeking in. I did tell the physician she only had one line and that either the antibiotic or platelets would be delayed as the patient was refusing another line attempt. MD wasn't worried about it as long as it all got in in the morning.

[turnforthenurse, MSN, NP]

I would give the platelets for the reasons listed above. Platelets and FFP are given rapidly where I work, usually over 20min. They have special tubing that is incompatible with our pump so we have to run it by gravity. Since it is 0600, you could hang the platelets and be done with them then start the antibiotic. On the pot where I work you have an hour before and hour after to give a med before t is considered late.

[muskan123]

I am a critical care area nurse, we have to give antibiotics to patient within 1st hour of hospital admission in order to prevent from sepsis otherwise with passing of every minute we will lose the chance to survive the patient. I will prefer to transfuse platelets in first 15 to 20 minutes and then give antibiotics. Its better to maintain two access lines if there is plan for any transfusion. In your given scenario we are unclear that patient has symptomatic thrombocytopenia or asymptomatic and also do not know about the extent of infection and type of antibiotic.

[CoffeeRTC, BSN, RN]

So, a long term/ frequent flyer patient with poor IV access on an onocology unit...what about a medi port?

[yoga pants]

I would have hung the antibiotic at 0530 (at my facility we can give meds 30 min before/after due time) so it can infuse while I'm working on getting the platelets from the blood bank and checking it off w/ another RN. I can understand that you want to try to limit waking up the pt in the middle of the night, but at the same time I'm not going to delay treatment because my pt doesn't want to be woken up. Unfortunately, the hospital is not the place to get sleep. However, I am a critical care nurse so my priorities are probably a little different. If I was in your situation and hung the med late because I didn't want to wake up my pt I would be laughed at by my managers, and would probably get corrective action for a med error. But even when I've had a pt who has been in the ICU for months I still don't think twice about waking up my pt to give meds, etc, because IMO, they're in the hospital to be treated and my job is to give them the treatment ordered.

Also, only having one IV makes me extremely uncomfortable…but thats the just ICU nurse in me.

[suanna]

Do I understand this right- you are giving platelets to a patient who has no signs of bleeding or invasive proceedures planned? Platelets do not "build up" in the patients system the way you can see with PRBCs transfusions. Any increase in platelet count will be very transitory. It is a waste of blood products and a risk to the patient-(the more foreign blood products given to a patient the greater chance of developing sensitivities that can result in very dramatic reactions with subsequent transfusions) to give platelets just based on a number. Not that it is your choice to give or not to give the platelets- that is the doctors call, but given the fact that the platelets are likely to do no good and may cause harm, and the antibiotic is likely to do some good and do little harm, I'd give the antibiotic and let day shift waste thier time.

[sistrmoon, BSN, RN]

So, a long term/ frequent flyer patient with poor IV access on an onocology unit...what about a medi port?

Port would still only allow one infusion at a time unless it was a double port or the two infusions are compatible(which obviously they wouldn't be in this case.)