TPN and PRBC

Nurses General Nursing

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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

Maybe the OP put up this post just to "see" the reaction . . . and there certainly has been a reaction . . . me thinks that he/she is sitting at home, laughing and sipping a latte!!

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Specializes in ER, OR, PACU, TELE, CATH LAB, OPEN HEART.
Maybe the OP put up this post just to "see" the reaction . . . and there certainly has been a reaction . . . me thinks that he/she is sitting at home, laughing and sipping a latte!!

One can only hope!!!!:jester:

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Specializes in Med Surg, Ortho.
According to your AllNurses profile, you are in nursing education and have a MSN. Have you practiced as a bedside nurse? My question has to do with basic patient safety and basic bedside nursing, standards which have not changed over time.

What are you thinking? You are going to kill someone someday!

STOP AND THINK! ASK QUESTIONS!

MSN?? Oh my goodness!

There are a lot of good posts here, the OP is probably afraid to come back after

all this, but I do hope he's reading all this good advice.

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Is carrier fluid the same as a "primary line" or "maintenance fluid"?

I would have run the antibiotic through the port the primary line is going in? While that is running I would have gotten an order to Alteplase the clotted line. If I get that unclotted I can then hook my primary to that port. If I can't unclot it I would see what if any antibiotics are due and needed to run through the primary and ask the doctor if I can delay the antibiotics by a few hours to run the blood.

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Specializes in M/S, MICU, CVICU, SICU, ER, Trauma, NICU.

To all who are throwing stones...

This is a mistake, but NO ONE DIED and it was an HONEST MISTAKE.

I've seen worse mistakes at the expense of the patient and yeah by MEDICAL DOCS TOO...so can we cut this nurse some slack?

Obviously, he was big enough to share with us on this forum and in all honesty for those judging a bit too harshly...

don't forget the ol' adage...

There but for the grace of God, go I.......

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Specializes in M/S, MICU, CVICU, SICU, ER, Trauma, NICU.
Just a question.....What was your initial education that qualified you for NCLEX? Are you a second Bachelors Nurse or Direct entry MSN???????? Just curious.

This I would like to know...

Those direct entry people scare the bajeebers out of me. I've seen them make some stupendous mistakes....

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I'm trying to discern what happened. From what I understand you had a triple lumen with one clogged lumen, TPN, blood, and a carrier fluid? ordered but only two lumens. I'm not sure what you mean by a carrier fluid, we typically use that term from the normal saline that runs at 30ccs an hour with a PCA or something.

Anyhow, if you had two lumens you should have run TPN on one, blood on the other. In any case, if the pt did not have enough lines for the infusions, you should have contacted the physician to ask what they wanted to do. We would have either tired to unclot the other lumen or started a peripheral line.

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From the OP's previous threads it seems as if he/she is a SRNA...as in still working on a master's degree. One post mentioned being finished with didactic portion. I am nieve I guess because I didn't realize SRNA's hung blood and or TPN. Regardless it is something basic that any nurse should know and if it isn't something commonly done, all the more reason to check protocols and ask for help.

All I can say is oh my. Hope this is a serious wakeup call to slow down and ask for help. Nobody knows everything. The best nurses ask for help when they are not sure IMHO, best thing I learned in school.

Being a CRNA, you can't just guess on things. I honestly couldn't recall why what was done was wrong but in school they told us so many times that TPN is only for TPN and blood for blood etc.

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Specializes in Legal, Ortho, Rehab.
This I would like to know...

Those direct entry people scare the bajeebers out of me. I've seen them make some stupendous mistakes....

All I can say is wow. Everyone else already answered the OP's question and than some! I just read an article in one of my nursing journals, that had some "research" supporting why direct entry with a BSN or higher resulted in better patient outcomes...hmm. It is not the degree, it is the practical experience. :twocents:

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Specializes in Pediatrics.

Okay, I am going to claim complete ignorance here & say, huh? What is a direct entry BSN or higher???

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Some schools only require a bachelors degree - as in if you have a BA in economics, you can enter into a grad program to become a NP for example and earn a MSN and sit for the NCLEX all within this 2 year program.

Okay, I am going to claim complete ignorance here & say, huh? What is a direct entry BSN or higher???
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Specializes in Pediatrics.

Thanks for the clarification 2bRN2010. Actually i have run across a few people in my masters program who are doing that...a very interesting breed there (a wee bit concerning...although I would hope that not all of those going from non-nursing bachelors to masters degree are like that).

I am actually an accelerated BSN who has been working in the field for 3+ years....from what I have seen, I think that there are "scary" people from all types of degrees...& fields for that matter (some of our MDs can be quite interesting/scary).

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