TPN and blood transfusions

  1. I'm a new grad, still on orientation, on a med surg unit. Last night I had a pt who had TPN running thru a mediport in her Left chest area. I had to transfuse 2 units of PRC's, the charge nurse said it was ok to run it with the TPN (she had a Y-Port). Anyway, I did it that way and one of the dayshift nurses said that you never run anything with TPN, I'm so upset. The pt did fine, the blood went in fine. If any of you know about TPN and blood transfusions, let me know.
    Thanks, Dixie :uhoh21:
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  2. 18 Comments

  3. by   nexus
    Hi Dixie,
    We give TPN through a 'dedicated line' meaning nothing ever goes in there except TPN. Shouldn't have a Y port on it.
    Not your fault, the charge nurse shoulda known better - you know now.
  4. by   Tweety
    We do the same as Nexus said, TPN by itself always. Blood isn't really compatable with anything but normal saline. Now if the patient had a triple lumen with three separate dedicated lines, then it's o.k. to run the blood. If it's a port with a y-connection where they mix at the end, that was wrong.

    You live and learn. Give yourself a break.
  5. by   suzanne4
    5% glucose can cause lysis of blood cells..................TPN usually has well over 10% glucose. If you remember what you learned in school, if you had 5% glucose infusing and were going to use the same site for blood, always flush the line first with normal saline to remove any glucose.

    If your patient has a central line that is a double or triple lumen, then you can use one for TPN (which is dedicated) and one for blood. But otherwise, never..........................
  6. by   Dinith88
    Quote from suzanne4
    5% glucose can cause lysis of blood cells..................TPN usually has well over 10% glucose. If you remember what you learned in school, if you had 5% glucose infusing and were going to use the same site for blood, always flush the line first with normal saline to remove any glucose.

    If your patient has a central line that is a double or triple lumen, then you can use one for TPN (which is dedicated) and one for blood. But otherwise, never..........................
    Good post and well said Suzanne!

    Lysis of the blood cells would have 2 major problems..1) obviously, she won't be getting viable blood cells..and 2) lysis of red cells can cause a spike in K+, which can cause big problems..obviously. Hopefully, the effects of the 2 drips being mixed together was somewhat offset by the speed of the infusion..(if both tpn and rbc's were run at rates>100 or so....)..but thats just a guess.

    The best thing to come of this is that you'll never do that again I think we learn best from our mistakes.

    ---------------------------
    That said, i just want to say 'that said'.
  7. by   nekhismom
    Ditto what has been said above. Blood is only compatible with 0.9% Normal Saline.

    I've made lots of mistakes while on orientation, too. You have to give yourself a break sometimes. Live and learn from your mistakes. You preceptor should have picked up on that WAAAAY before the blood was even started. Is it possible that it WAS a double or triple lumen and not just a Y-port??
  8. by   suzanne4
    Quote from nekhismom
    Ditto what has been said above. Blood is only compatible with 0.9% Normal Saline.

    I've made lots of mistakes while on orientation, too. You have to give yourself a break sometimes. Live and learn from your mistakes. You preceptor should have picked up on that WAAAAY before the blood was even started. Is it possible that it WAS a double or triple lumen and not just a Y-port??
    If it was a medi-port, these are ports usually used for chemo. They are implanted, usually in the chest, in the OR. If the TPN and blood were put together at a Y-port, there is a problem. There are some douple lumen ports out there, but again you would not see fluids Y-connected to access them
    And blood can also go with Lactated Ringer's Solution, the contraindication is anything with glucose. Many hospitals actually use LR more often than NS, especially in emergency departments.
    The only time that LR is contraindicated in a patient is because they are a renal patient and LR contains potassium.
  9. by   nekhismom
    I've never used or seen anything used but NS. I remember being told over and over in school that ONLY 0.9% NS was compatible with blood. NOTHING ELSE, EVER was the motto. Interesting.
  10. by   suzanne4
    Quote from nekhismom
    I've never used or seen anything used but NS. I remember being told over and over in school that ONLY 0.9% NS was compatible with blood. NOTHING ELSE, EVER was the motto. Interesting.
    Many ORs and ERs use lactated ringers, especially with trauma patients.
    We have been doin it this way for years. Only difference between the two is potassium.
  11. by   cincygirlpnp
    At the pediatric hospital where I work, we routinely run stuff with TPN and lipids. Most abx are approved by our pharmacy to go run with TPN. The one med I can remember right now that isn't compatible with TPN (crystalizes) is gangcyclovir. But I have never run blood products with TPN
  12. by   suzanne4
    Lipids are actually an admixture of TPN. Many hospital pharmacies mix the two actually together. Pediatric TPNs do not usually contain near the amount of dextrose that adult patients use. Many things are combined in NICU that you would never see in any other unit. However, blood is never mixed with TPN, even at the Y-connection as it will cause lysis of the cells.
    Which means that you have essentially wasted that unit of blood, as the patient will get no benefit from it. It also becomes harder on the kidneys trying to filter out the waste from those cells.
  13. by   JWRN
    LR should also not be used in those patients with liver disease, as they will not be able to breakdown the lactate contained in the LR, thus causing a lactic acidosis...
    TPN should always be run by itself, nothing y-connected to it. Blood is compatible with both LR and NS is what I learned...A long time ago I learned that only NS was compatible with blood, but have seen it many times with LR from the OR...

    Original poster, everyone makes mistakes, learn from them and move on.
  14. by   NurseDixie
    Thanks to everyone who answered my question. My pt's Hemoglobin went from 8.6 to 9.9. She was discharged the next day. I'll know better the next time I hang blood products.

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