Should A Pharmacist Holds PN During Blood Transfusion

The practice of holding Parenteral Nutrition 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 to taper PN rate by half for at least one hour depends on the dextrose concentration in PN. ( no need if patient receiving peripheral PN)

Furthermore, you may recommend fingerstick at the mid of blood transfusion. Regarding, IV lipids you may advise the nurse to commence I.V. lipids after blood transfusion is completed.

So to make it simpler:

1. 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.
2. There is no absolute contraindication of infusing blood with the same time with PN and Lipids using different lumen unless if the patient is fluid overloaded.
3. Most patients can tolerate the low infusion rate of lipid same time with Blood transfusion; however, most clinicians don’t favor discontinuation and manipulation of lipid.
4. If the patient is at risk of fluid overload, then hold PN; hold lipid and resume after blood transfusion.
5. 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.

Hope this helps.