Question on pt with a picc line and infusing blood and TPN

NurseyBaby'05, BSN, RN · Sep 10, 2008

See duplicate thread

JBizzleRN, ADN, RN · Sep 10, 2008

Well I would have probably stopped it also, I guess depending on the patient. I mean you could throw them into fluid overload if they have CHF or other problems of the like. I mean depending on how fast your run your blood in. We generally run ours in about 150-175ml/hr depending on the patient. That with the TPN/Lipds coudl equal almost 280ml/hr...which IMO would not be a good thing.

ulianka · Sep 10, 2008

What about the rebound hypoglycemia? In our hospital, we have a policy to run D10W at the same rate as TPN infusion for 4 hours after the TPN is stopped, following by D51/2NS at 1/5 of the rate of TPN infusion.

accessqueen · Sep 11, 2008

There are two possible directions to this question. One, is it OK to run TPN and blood through the same PICC. A multi-lumen PICC is meant to run more than one thing at a time. So no problem there. THe question of fluid overload is another issue, one that should be determined by the MD if you think there is a possibility of a problem. TPN should not be suddenly shut off, due to possibility of hypoglycemia. Blood can be run over 4 hours to prevent overload. If a patient is anemic and malnutritioned, they probably need all the volume. Many times lasix is ordered between units to minimize overload. It's up to the nurse to assess, it's still up to the doc to make the final call.

nrsang97, BSN, RN · Sep 11, 2008

There are two possible directions to this question. One, is it OK to run TPN and blood through the same PICC. A multi-lumen PICC is meant to run more than one thing at a time. So no problem there. THe question of fluid overload is another issue, one that should be determined by the MD if you think there is a possibility of a problem. TPN should not be suddenly shut off, due to possibility of hypoglycemia. Blood can be run over 4 hours to prevent overload. If a patient is anemic and malnutritioned, they probably need all the volume. Many times lasix is ordered between units to minimize overload. It's up to the nurse to assess, it's still up to the doc to make the final call.

I agree.

iluvivt, BSN, RN · Sep 15, 2008

Yes that is correct. Multti-lumen PICC lines allow for incompatible fluid and medication administration with each lumen being separate. Do not routinely slow or shut-off TPN without an order or a really good reason due to the rebound hypoglycemia. Recent studies have shown that D5W is every bit as effective as D10 in preventing this if you suddenly lose your CVC access or any other reason for an abrupt cessation of the TPN. Many hospital policies have not caught up this as of yet and still hang D10 in these situations. I agree adjust the blood administation if needed. If a patient must be given smaller amounts of blood the Blood Bank can make smaller bags volumes for you.:zzzzz

litbitblack, ASN, RN · Sep 18, 2008

yes that is the whole purpose of multilumen. the d10 is only for use If you lose the line or the bag runs out until you get another one.

2soldiers44 · Oct 7, 2008

I agree completely with this statement. In the end it depends on the pt's condition. Why are you giving blood? Ie: just a low H/H or rapid blood loss and how many units are you giving. There are too many unknown varialbles but all in all you can run both at the same time and if you are worried about fliud overload just keep assessing the pt. At one ICU that I work at they have included lung sounds on the blood bank documentation form.

classicdame, MSN, EdD · Oct 7, 2008

Our medical director for our lab is accessbile to answer questions on unusual cases like this. Might try calling there to get an answer for the "next time".