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

IV fluids are often stopped while blood is transfusing to avoid fluid overload, but not TPN unless there is a specific order. You are correct re: the multiple lumens. I've even gotten a second IV placed to transfuse if I need it.

You need to be cautious re: fluid overload depending on how fast the TPN is ordered and the pt's medical hx. You can always get some Lasix ordered if you need it.

If a pt is on TPN, you have to figure that his nutrition is not the greatest to begin with. You want to do as little as possible to further compromise it.

On our unit we stop the TPN especially if it is y'd in together because in that case it would be mixing. I would have stopped it.

The amount of blood passing thorugh the superior vena cava (where the tip of the PICC should be) is over 2 liters per minute. There is no "mixing" due to the large volume of blood flowing in this area. As long as it is a double or triple lumen, and the patient's heart can handle both rates of fluid simultaneously, blood and TPN can be given together. Usually the rate of the TPN is decreased during the infusion.