TPN and PRBC

scootertrash nurse · Dec 25, 2009

nothing infuses with Blood ! !

nothing infuses with TPN ! !

Tpn has such high glucose and fat calorie content easily grow bacteria

get another line call the doctor and educate them on the need for more iv sites and or activase the clotted port

MERRYWIDOW46 · Dec 25, 2009

NOTHING other than 0.9NSS EVER is infused with bloo!!!!! You are lucky all that happened was a write up.

Did the patient have a reaction?

TPN also should not be run with other things.

Do some research.

If in doubt check with the charge nurse, look at hospital/facility policies and procedures, contact the physician.

Please educate yourself about IV compatability and admixtures.

Good Luck.

EDRN-2010 · Dec 25, 2009

What I have been taught is that a TPN line is only for TPN and that you never stop a TPN transfusion abruptly and you never run anything with it. We have been told to get a new line started. I am surprised they didn't elaborate as to the exact reason for writting you up so you would know why. I think it has to do with infection because of the high glucose content but I can't remember. Hopefully somebody answers you!

I had a patient today with no peripheral IV access (he was very edematous) and a TLC SC with one lumen clogged, the surgeon ordered 2 Units PRBC I had carrier and and TPN, I plugged the blood in and the TPN into the blood so i could still have carrier fluid.I was written up. anyone have any feedback?
Thanks!
JC

EMSnut45, BSN, RN, EMT-P · Dec 25, 2009

I'm a new grad in an ICU, but I'll take a stab. I was taught, and our unit policy is that blood products run by themselves, and TPN can only run with lipids. If I had one port clogged, I would have done one of two things:

1. Stopped the "carrier" fluid and run the PRBC's through that port -OR-

2. If the "carrier fluid" was important (I've never heard of that term, so I'm not exactly sure what it is), then I'd ask the physician to write an order for alteplase to un-clog the third port.

We use alteplase on a regular basis in the ICU that I work in. Our patients are extremely sick, and we always need as many ports open as possible. If alteplase doesn't work, the physician will usually reinsert another TLC over a guide wire.

Being a new grad, I always have questions about what IV fluids can run with what, double checking the policies when I start drips, etc. I've learned how to search the hospital's policies and procedures, and usually ask a more experienced nurse their opinion as well.

I'm sorry that you were written up! That kinda ruins the holiday season. Best of luck to you.

mjjlRN · Dec 25, 2009

Sorry, I would have never done what you did. The ONLY thing I have ever even heard of piggybacking into TPN is Lipids. The only thing I would ever piggyback with Blood products is NS. I'm not sure what you mean by a "carrier", though. Is is something that could have been held for the length of the blood transfusion? if not, I would have either started a peripheral line for the blood or carrier, or I would have contacted MD about declotting the TLC's other port.

Creamsoda, ASN, RN · Dec 25, 2009

Well, dont do it again? And maybe read up on blood and tpn administration. You never run anything with blood other than NS. Theres one other drug you can but its not given often...cant remember the name. Same with tpn. TPN is always run on its own! Its basic nursing so they were right in writing you up. In this case, I would have stopped the tpn for the transfusion and told the doc.

RedhairedNurse, BSN, RN · Dec 25, 2009

You did what? You should proof read what you wrote and see that it's hard for me to understanding what you're saying. Please be more clear and don't use abbreviations, are you saying he had triple lumen subclavian and that you piggy backed the blood into the TPN? This is what it sounds like you're trying to say.

If you did this, then yes, I think you should be written up. With his current situation of being so edematous, I would have done possible two things:

a) Infused only the blood. You can put somebody at risk for fluid overload by running too many fluids at once, esp if they're already edematous. They would need to be monitored very closely IMO if you ran fluids along with the blood.

b) Called the doctor to get an order for ativase to unclog the port and also got an order to hold TPN while blood infuse.

FockerRN · Dec 25, 2009

You never, NEVER, run blood with anything but Normal saline. Running anything else with blood can cause major issues, if not death.

No wonder you got written up, the ultimate no,no that was taught ad naseum in nursing school.

RedhairedNurse, BSN, RN · Dec 25, 2009

You did what? I don't really understanding what your saying. Did you proof read what you wrote here?

I'm thinking that you piggy backed the blood into the TPN fluid? If so, then yes, this is a big no no, you don't do that. It's understandable as to why you were written up if you indeed did what you say. Depending on the rate of administration, you can put someone in fluid overload giving too many fluids at once. Are you a new nurse? You should ask questions to make sure you're practicing safely.

lvICU · Dec 25, 2009

Not sure if this is legit.

You can't run either TPN or PRBC with any other fluids.

Lacie, BSN, RN · Dec 25, 2009

Nothing should ever be piggybacked into TPN or vice versa with Blood products. Did they try to declot the other lumen with cathflo/activase if they were unable to start a peripheral line? Keep in mind TPN is also the perfect medium for bacterial growth, etc. Look up your unit policy/procedure for TPN administration and also for blood products.