[tory]

I remember all through school having it drilled into my head that TPN was to infuse by itself and never to piggyback ANYTHING else into it. Where I work RN's consistently piggyback numerous drugs into the TPN line. Most often it is antibiotics, pepcid, morphine and zofran/phenergan. I am currently searching for info on this from the internet, but in the mean time would like your input. Thanks!

[AHarri66]

The ONLY thing we infuse with TPN is lipids, and that is attached below the filter.

[passing thru]

Are you in a major teaching hospital Tory?
Or a major cancer center?
Are these triple lumen central catheter intravenous lines?

In major cancer hospitals I worked in, and in some teaching hospitals, it was the same as you say.

Patients simply have so many intravenous medications....everything goes thru the TPN.

I have not seen any adverse or negative consequences .

[WhiteCaps]

I agree, NOTHING but lipids are to piggyback into TPN. There is too much risk of contamination/sepsis. We recently had a pt with only one central line site who was on TPN/Lipids. With the doc's written instruction, we did piggyback into the line because there was no other available access. That pt got septic, despite the most careful sterile techniques.

[passing thru]

Maybe the patient got septic from another cause.

Only if the catheter was removed that day and cultured by lab with blood and urine cultures, can you say with even minimum certainty
that
the
i.v.
was the source of the infection.

you can have a wound infection, an infected tooth, a UTI, and become septic

AND contaminate the iv catheter with bacteremia from those sites.

[passing thru]

tHE # 1 RANKED cancer center in the U.S. has been doing this for 25 years.

Their pts. have low white blood counts D/T immunosuppression.
I don't think they would put their patients at risk if infection were that easy.

One thing they DO NOT DO IS,.....DRAW BLOOD FROM A CENTRAL LINE.

TPN & lipids, antibiotics, iv therapy, yes , all go thru tpn line.

[tory]

Thanks for the QUICK replies! And to "Passing Thru",...yes, I work at a major teaching hospital and it is the largest in our county. We have TPN most often through a PICC or it's peripheral parentral nutrition through an IV.

[gwenith]

TPN is very acidic and some solutions are alkaline so there is a PH incompatablity. You can get dual lumen PICC lines and certainly triple and quad central lines.

Apart from the sepsis angle there is actually little researched and verifyable information about drug interactions within IV lines. Yes! there are texts that list what does and does not mix but not every drug is tested on every possible admixture.

Just because you do not "see" an interaction taking place does not mean that one has not occured.

[WhiteCaps]

I'm puzzled why Passing Thru says not to draw blood thru a central line? That's the first time I've ever heard that one. Why not?
When pt's have no available peripheral sites, that is the only way to get the labs! What do you do?

[lsearl]

I agree, WhiteCaps. In home care, we draw blood from a central line all the time.