Sunday, May 16, 2004

Nurse X: "Doctor Parker, we need a central line on Mr. Jones"
Me: "Why does Mr. Jones need a central line?"
Nurse X: "He needs blood and has meds going through his peripheral sites"
Me: "Why can't you piggyback the blood on?"
Nurse X: "We just can't"
Me: "Why?"
Nurse X: "The medications may be incompatible with blood"
Me : "Say again?"
Nurse X: "I said the medications may be incompatible with blood"
Me: "What is that medication mixing with when it leaves the IV catheter?"
Nurse X "Well, I've never thought about it that way"

Nurse X and I chewed over this while I was placing Mr.Jones' line. We cane up with two reasons, one of which I eliminated later:

Reaction problems: If you are giving a medication and blood through the same line, and the patient has a reaction, was it caused by the blood or the medication? This is probably not the reason since blood and meds can be given through different ports of a central line at the same time.

It's not the blood, but what it's mixed with: The medications may be incompatible with the citrate used in the preparation of the packed cells.

Can anyone give a logical explanation as to why you can't piggyback medications with blood? I don't ask for chapter and verse citations, but something other than the dogma of"that's just the way it has always been done" would be most appreciated.
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