Hello,
The practice of holding PN during blood transfusion is to avoid fluid load in short time that may affect cardiopulmonary system.
The average of blood transfusion is between 1 to 4 hrs depending on the number of units. except platelets that may take just less than one hour. In case of blood transfusion,, you have taper PN rate by half for at least one hour depends on the dextrose concentration in PN.( no need if patient receiving peripheral PN).
Also, you may recommend finger-stick at the mid of blood transfusion.
Regarding IV lipids, you may advise the nurse to begin IV lipids after blood transfusion is completed.
My thoughts are as follows:
- Make sure not to infuse Lipid and PN through the same line as Blood; Using the same line of PN and Blood is an absolute contraindication and might cause Blood Dyscrasias.
- There is no absolute contraindication of infusing blood at the same time as PN and Lipids using different lumen unless if the patient is fluid overloaded as mentioned by Hamdy
- Most patients can tolerate the low infusion rate of lipid same time with Blood transfusion; we don’t favour discontinuation and manipulation of lipid
- If the patient is at risk of fluid overload, then hold PN as mentioned by Hamdy; hold lipid and resume after blood transfusion
- If you know the time of blood transfusion in advance, try to start lipid after completion of blood transfusion. So you avoid holding and restarting.
.
