What is the best evidence based practice for administration of blood products through a dual lumen PICC line? I have always been taught to never let blood mix with anything and have a dedicated line for admininistration due to possible transfusion reactions. Some staff are saying that a lumen of the PICC is safe despite the other lumen having medications infuse simultaneously. I was given a British Study from 2007; Guidelines on the inseriton and mangement of central venous access devices in adults from the International Journal of Laboratory Hematology, Int. jnl. Lab Hem. 2007, 29, 261-278.
Thank you for any help with this.
All catheters with multiple lumens prevents contact between infusing fluids/meds/blood when each lumen is dedicated to each type of infusion. When all infusions exit from the catheter tip into the bloodstream there will be contact. With a few drugs that have extreme issues with compatibility, there could be some mixing at the catheter tip that could cause precipitate to form, but this is probably only a very few drugs and I am not aware of any research on this issue. I am not familiar with the document you referenced and do not know what it says. However, the only problem I see with infusing blood through one lumen of a dual lumen PICC is the fact that the length of the catheter causes a much slower flow rate than if the blood is transfused through a short peripheral catheter. I would evaluate what is infusing through the other lumen. Can or should these other fluids and meds be stopped during the blood transufsion? Is is reasonable to put in a peripheral catheter for the blood? I would not apply the standard of infusing blood without other fluids and meds to this dual lumen PICC. I would infuse the fluids and meds through one lumen and the blood through another at the same time. The patients blood, the transfusion blood, the fluids and meds are going to come into contact once they enter the bloodstream anyway. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
watch the infusion volume - be careful not to overload that patient!
Thank you so much for your quick response. When the issue arouse the general thought (at my facility) concerning this was to run the blood alone if at all possible or at least until you are past the 15 minutes to ensure that the patient was not going to have a blood transfusion reaction. Then you can use the other lumen for abx, or fluid as needed. I cannot find this addressed in INS and wish there was some research concerning this.
So true concerning the volume. Our population is elderly and CHF is prevelant. For most of these folks the blood trainsfusion is volume enough and some require lasix inbetween units.
Volume to be infused can be a concern in some patients and I totally agree that it must be considered in your assessment. One unit of packed RBCs equals about 250 mL. If infused over 4 hours, this would add ~60 mL per hour to the fluid intake. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861