TPN and PRBC

Nurses General Nursing

Published

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

I totally agree. I think direct entry programs are great for some people, just like the accelerated programs, and standard programs. I think the scarriest thing is that some programs (no matter which type) are not going over basic concepts or that the students aren't picking up the basic concepts. I hope to become an NP but I still find all of the basic RN information quite important to building a solid foundation. A good friend of mine became a nurse in 12 months with no previous medical experience and she is great, seriously born to be a nurse I think.

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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Specializes in CRNA.

[color=#333333]you can only interrupt tpn for 30 minutes or hypoglycemia will occur; it can not be abruptly stoped but needs to be tappered at rate of 1/2 rate over 1-2 hours. total parenteral nutrition.

[color=#333333]from the op’s profile and description of the snafu, it sounds as if the patient was in the or. i am not that concerned with hypoglycemia from discontinuing tpn intraop. the stress of the surgery alone jacks up cortisol production in the zona fasciculata 10x that of normal levels. put in an aline and check some blood sugars intraop. either way, if the dude was having issues with his lines and for some unknown reason did not want additional access, it would seem logical to stop the tpn in order to complete the organ transplant aka blood transfusion.

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Specializes in ER, OR, PACU, TELE, CATH LAB, OPEN HEART.

OK now I am REALLY scared!!! I looked at all the OPs postings. The OP is a NEW CRNA, this happened in the OR during surgery. YIKES!!!!!

These were my worst nightmare when an OR nurse, Anesthesia Providers be they MDs or CRNAs who were unsafe practitioners. I worked in teaching institutions with residents and srnas as well as non-teaching with staff MDs and CRNAs.

The OP is obviously "intelligent and book smart", however, lacks the ability to put what has been learned into practice and problem solve or think on his/her feet. These are the "MOST DANGEROUS" kind of provider.

Please tell me OP which state do you practice in?????????

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OK, dumb question - I also was taught that we never run TPN with anything but lipids and we don't stop it abruptly. I was also taught that we never run blood with anything but NS.

What I don't remember on these issues is "why". Yeah, I could look it up but am wondering if someone would indulge me being lazy and share what they know about the "why". Hey, it's Christmas. Gift me? I hope you all had great Christmas, even if you had to work like I did. My shift was busy but not bad at all. Everyone seemed determined to be happy and we were.

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Specializes in Med Surg, Ortho.

He's a CRNA or SRNA, oh my gosh, that's even worse!

Doesn't a nurse have to have 2-3 years of ICU exp before going into CRNA school?

Wouldn't that have given this OP enough experience to know you don't infuse PRBCs

with TPN?? Geez, for heavens sakes. I still can't get over this situation of his, I know

we all make mistakes, but man, this was a doozy.

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Specializes in Med Surg.

The most important thing right now is that no one died thank God. It was a mistake and a learning experience.

Next time, make sure to ask questions when in doubt and if you are doing something you have never done before, don't just rely on so called "common sense", get verification from someone more experienced with that task before you do it.

Count your blessings and from now on be more careful

Best Wishes

"This too Shall Pass"

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Specializes in intensive care major medical centers.

profile states nursing education I guess he/she teaches other nursing students or crna's QUIT TEACHING!!!!!!!!!!!!!!!!!!!!!!!

I just cant let this go it really bothers me.

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Specializes in CRNA.
profile states nursing education I guess he/she teaches other nursing students or crna's QUIT TEACHING!!!!!!!!!!!!!!!!!!!!!!!

I just cant let this go it rally bothers me.

Let it go man. He is not in nursing education; his nursing education is RN-MSN. That is the only thing he filled out on the profile. Just as on your profile it reads under nursing education, RN ASN.

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Ya know... although upsetting I will remember/learn from this thread as it has burned a place in my brain. Good that some have given learning info as they seem naturally inclined to do. Many thanks to you guys from all of us who have read your posts and tapped your links.

Some others are seriously tempting the bad karma gods. Careful, you don't want to be doing that!

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Specializes in ER, OR, PACU, TELE, CATH LAB, OPEN HEART.
Ya know... although upsetting I will remember/learn from this thread as it has burned a place in my brain. Good that some have given learning info as they seem naturally inclined to do. Many thanks to you guys from all of us who have read your posts and tapped your links.

Some others are seriously tempting the bad karma gods. Careful, you don't want to be doing that!

WHAT are the "Bad Karma Gods" and HOW does one TEMPT them. What do they do???????????

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

You just reiterated my fear.

LACK OF EXPERIENCE. Should I further expound? I wouldn't get me started. If an SRNA did this, she/he will be giving anesthesia.

Think about that.

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Specializes in M/S, MICU, CVICU, SICU, ER, Trauma, NICU.
profile states nursing education I guess he/she teaches other nursing students or crna's QUIT TEACHING!!!!!!!!!!!!!!!!!!!!!!!

I just cant let this go it really bothers me.

I work with two CRNAs that are petrified of me as I have caught them do some stupid stuff.

They know one more thing I catch them doing wrong, they are out the door.

I have been instructed to do as such by the head anesthesiologist.

My group is realizing that ONE YEAR as a bedside nurse is NOT cutting it and they are no longer hiring "fresh" grads with less than 3 years of experience.

Yes, people, guess what? Your lack of bedside SHOWS.

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