What would you have done?

[Sadie04]

The other day at work I had a patient admitted for an infected hip prosthesis; he had a revision and was on IV antibiotics post-op. His medical hx included a cardiac valve replacement, so he was on a heparin drip. There was a student nurse assigned to the patient; the nursing instructor works per diem on my unit. His crit was 25 so I was getting ready to hang some RBC's. He had a double lumen PICC with the heparin infusing through one port, and I was infusing the blood through the other port. I was explaining to the student the protocol for transfusion when the instructor came in and said to the student "are you ready to hang his antibiotic?" I gently reminded her of the hospital policy that heparin must run alone (we can't piggy-back anything with heparin, insulin, blood or albumin) but she said "I called the pharmacy and they said heparin and ceftriaxone are compatible." I didn't want to argue or cause a scene, but I didn't think it was appropriate to set that kind of example for the student! So I said "let's wait until after the blood is done." The instructor took down the antibiotic and left the room. I'm don't know if I handled the situation right...

[lisaloulou]

For one thing, I didnt think you could have blood go through a picc line, I thought it would damage to many blood cells as it was pushed through. As for the abx and heparin, you did the right thing. it would give the pt a mass bolous if you were to let have the abx pump what was in the line prior to the abx.

Regarding the PICC: I use 5F and 7F PICC lines, not only can you draw labs and infuse blood, you can monitor CVP if you like. The 5F double is approx. like 2 18G regular IVs and the 7F double is approx like 2 14G regular IVs. With optimal placement, those babies will ZOOM infuse if need be. The "old" PICCS are 3F and not much good for anything in my humble opinion.

A well placed PICC is a work of art.

[Agnus]

It sounds like you handled it very graciously. Though the Hep may be compatible, I can understand the reasoning for the policy.

You were ultimate responsible for this patient not the student not the instructor.

The policy is there for a reason.

I think the instructor got the right message as she took it down and said no more.

When there is a policy in place that specifically says not to do something even when you have verified the safty of doing it, you have a legal obligation to follow policy.

Unless you can clearly demonstrate that following policy would cause more harm than violating policy you need to stick with policy.

[mittels]

Regarding the PICC: I use 5F and 7F PICC lines, not only can you draw labs and infuse blood, you can monitor CVP if you like. The 5F double is approx. like 2 18G regular IVs and the 7F double is approx like 2 14G regular IVs. With optimal placement, those babies will ZOOM infuse if need be. The "old" PICCS are 3F and not much good for anything in my humble opinion.

A well placed PICC is a work of art.

Thanks for the info. Its been 3 years since I worked in the hospital enviorment and things change so much in that period of time.

[jemb]

I think you did fine. I would not hang an antibiotic PB on a primary heparin drip, nor would I hang an antibioic anywhere to run concurrently with blood.. If the patient had a reaction, how would you know whether the reaction was to the blood or to the abx?

[Rapheal]

I think you did fine. I would not hang an antibiotic PB on a primary heparin drip, nor would I hang an antibioic anywhere to run concurrently with blood.. If the patient had a reaction, how would you know whether the reaction was to the blood or to the abx?

Thank you , thank you, thank you. Recently I got reamed by a nurse following my shift for not running both blood and a new abx. The patient was very frail, with a hx of CHF. I used the same logic you did. Glad to see I am not the only one who thinks this way.

[BadBird, BSN, RN]

I believe you handled the situation correctly. Just because the instructor says one thing doesn't mean anything to you, YOU are responsible for your patient. That was a good learning opportunity for the student to call the pharmacy and learn about compatability.

[kimmicoobug]

Personally, I would much rather just leave my hep drips alone. I will start a new site if I have to. And as someone mentioned early, I would worry about giving a bolus. I would have done the same thing

[SnowymtnRN]

I was always taught the big 3 drugs that couldn't be ran with anything else.

1. Heparin

2. Insulin

3. Theophylline

AND the instructor was probably just questioning, it was nothing personal. But remember had something happened, an interaction, etc...YOU would have been responsible as the primary RN not the instructor or student. Stand your ground, who cares if you make a scene. I mean had she pushed i would have said "umm no. not going to happen, i'm not comfortable with that and this is ultimately my responsibility."

I think you did awesome.

[Stitchie]

Your hospital's policy is the Golden Rule for "what do I do" type situations, and just because a drug is compatible doesn't mean it's a good idea. You followed your instincts and policy; if the instructor complains, you have the hospital policy to back you up.