If the Cytarabine is continuous, you likely have a 'baseline' of the patient's response to it. Each lumen is a separate access, it's going in a huge vein with high turbulence, so you could ostensibly put anything in either lumen and be fine. This was a debate on our unit too, and you'd walk in at change of shift and find nurses doing it differently and having good reasons for it. I had a nurse recently give Calcium Chloride through a PIV when she had a perfectly good central it extravasated.I treated it but it still blistered some! You always need to know what you are giving and look up the ph and osmolarity if you are using both PIVs and CVCs so you can select the best options and set up. It is not incorrect what he did it is just the Vancomycin is more irritating and you always want to give the most irritating medications through a central line if you have one. Blood and blood products can be administered through a PICC as well but since it it so viscous it may have been easier to administer through the short PIV. The Vancomycin is very aciditic and is more apt to cause a phlebitis and infiltration than blood. It would have been best vein wise to administer the chemotherapy and the Vancomycin via the PICC and given the blood via the PIV. It is one tube but it is split down the middle all the way to the distal end so that both infusions will exit in the SVC with a very high blood flow rate providing excellent hemodilution. I don't recall the exact information our CNS provided at the time to prove the safety of such a procedure, but the following is from a quick Google search: Our concern, of course, was if the patient had a reaction to the chemo or the blood, how would you know which one was causing the reaction? However, this patient was ill enough that if they didn't receive the blood, we were going to have to stop chemo, so in the end, we infused both and everything turned out fine. For the same reason you can run TPN and an antibiotic on two lines of a PICC, you can also run chemo and blood-they're not going to mix in the process of infusing. After many attempts to establish another site, our CNS came in and told us we were wasting our time as it was perfectly safe to run chemo and blood and whatever else you might need at the same time via different PICC lines. They had absolutely zero peripheral veins. We had a patient who was on a continuous chemo infusion much like the patient in your scenario who needed blood. We had this debate on my floor once, too. I attended a chemo provider course and was "checked off" for chemo administration by the senior "chemo nurses" before I was able to start chemo administration but that was it, and I'm pretty new to the whole oncology/chemo world. I asked other nurses on the unit (med/surg/oncology) and they were not sure. His response was that "well, _ (clinical supervisor) said it was okay" because one of the oncology MDs had once told her that it was fine to do so. However, when I returned the next night, the AM shift nurse had both the chemo and PRBC infusion going to that 2lumen PICC, and IV vanco on the peripheral. I transfused plts on the peripheral line since "you can not run anything with chemo infusion" (as I was taught by my preceptor). Additional peripheral line was established on opposite arm to allow for IV antibiotics/transfusions. Is it safe to administer chemotherapy and transfuse PRBC/blood products via 2 lumen PICC line? I was caring for a patient one night who was on a continuous cytarabine infusion x 7 days, and was having to receive PRBC/plts fairly frequently.
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