It is my philosophy to never (unless emergent situation) administer IV antibiotics simultaneously during a blood transfusion, even though a different PIV site or lumen of a multilumen CVC. This has been based on the high risk of a reaction from either the blood product or the antibiotic and if infusing simultaneously, not knowing which the patient is reacting to. I have searched the INS Standards, INS P&P resource, Infusion Therapy in Clinical Practice, INS Core Corriculum, etc.... thinking I would have sound backing for this. Not the case. Is this just best practice or am I in the minority?
There are no clear guidelines on this and it is a patient-based decision. You would never, not ever give blood and meds through the same lumen of any catheter. Before the blood is started, the nurse should assess the fluids and meds that are also ordered during the time the blood will be infusing. Consider the stability of the patient, the type and rates of fluids, any drugs mixed in the fluids, any intermittent meds scheduled, and the number of lines or lumens available or the possibility of inserting another PIV. I would usually prefer to keep all meds at their scheduled time and have a second line or lumen for the blood. If for some reason that is not possible, you will need to reschedule the meds. This could be considered a med error depending upon how your facility treats this. If the patient had been receiving the same meds with no problems for several doses, I would infuse both these meds and blood at the same time through separate lumens. If there are no meds at all, I might consider stopping the fluids to allow the blood to infuse. As an infusion nurse specialist who had responsiblity for managing all of these fluids, meds, and transfusions on a 42-bed nursing unit, I have made this assessment many times. This type of assessment and guidance is just one example of the benefits of an infusion nurse specialist. It is always what is in the best interest of the patient. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861