Transfusing blood and other meds????

[1_Dedicated_RN]

Hey Guys I Had A Patient The Other Day Who Had To Recieve 2 Units Of Prbc's I Started The Infusion And We Have 4 Hours For The Blood To Infuse The Patient Had About 3 Other Antiobiotics To Be Given I Know That The Only That Can Be Infused With Blood Is Normal Saline. My Question Is I Know I Could Have Started Another Iv Does It Matter Whether It Is Distally Or Proximal To The One Already Infusing Blood. Anyways After The 1st Unit Transfused I Ran 2 Antiobitics Then I Was Gonna Start The 2 Unit. Any Input Would Be Greatly Appreciated

[Daytonite, BSN, RN]

When I worked on IV teams we got called about this a lot. We put in a second IV access (saline lock). This is where knowing your vein anatomy is helpful. Ideally, you would like to put the second IV access in the other arm if you can. If you put it in the same arm as the transfusion, try to find a vein that is not the same one that the blood is infusing into or in a vein that empties into the one that the blood is infusing into. Knowing how to access the basilic vein on the back of the arm is a great choice and usually a large vein in many people. Ultimately, however, the goal is hemodilution of the blood product and the antibiotic and this is going to occur in the right atrium ventricle of the heart which is where the contents of all veins end up. Think of it as a great big mixing bowl. You just want to try to keep the blood transfusion and the antibiotic separated from each other in the smallest vessels for as long as possible.

[nursemike, ASN, RN]

The most persuasive rationale I've heard for not running meds at the same time as blood is that it would make it unclear whether an adverse reaction was to the blood or the med. That logic would seem to apply whether or not you used a second IV site. My inclination would be to reschedule the antibiotics. Running a couple of quick ones between units would seem okay, especially if they were ones the patient had already had without reaction.

As always, it would be best to look up the policies and procedures at your facility.

[iluvivt, BSN, RN]

It is best to start a second PIV with that many ABX ordered. One thing to keep in mind is that transfusions do not always go as planned,you may have to slow down if patient has a reaction. It is OK to use the same arm,just use a different vein. I tend to do that if able b/c it just makes it easier for the pt to get up to the BR and have one free arm for lab draws and other activities.