[ripcurl1]

I always thought that anything containing D10 or higher needer to be infused through some type of central venous line. I also thought that TPN must be administered by iteself. I recently started working for an institution who infuses TPN through a peripheral IV (NOT A PICC line) and will also combine meds and IVF with the TPN line. Does this sound right? Does anyone else do this at their hospital?

[scribblerrn]

I remember one instance of giving TPN through a peripheral line. It was while I was working as a floor nurse in a peds hospital. I only had the pt (Pre-schooler) that one night, but apparently the TPN had been running for about 3-4 days. The only thing about giving TPN peripherally is that it ruins the veins. I only remember this because at 2 AM the site went bad and we were unable to stick the kid in a better spot since he had averaged 2 sticks/day since the TPN started. I spent the better part of an hour arguing with the resident who didn't think a PICC line was warrented! "Just stick him again!" I finally harrassed him enough that the kid was scheduled for a PICC in the AM.

So I would say, if you have to it can be done, but it isn't the best thing for the pt.

Have never run fluids/meds with TPN.

[VivaLasViejas]

Well, I left hospital nursing over a year ago, but I can't imagine things have changed so much in 14 months that TPN is now being infused through peripheral IV catheters and mixed with IVFs or drugs of any kind. That sounds absolutely insane to me---the average person's veins would be ruined in nothing flat, to say nothing of the damage that could be done if there is extravasation. WOW.

[oMerMero]

Anything with D10 needs to go through a central line because it is so harsh on the veins. As far as running meds and fluids with TPN, it all depends on the hospital's policy. I have worked where we routinely ran meds with TPN/Lipds, you just had to be careful that everything was compatible. In that instance, the hospital provided a computer program so you could easily and quickly look up to see if everything was compatible. The pharmacy at that hospital also mixed meds directly into the TPN, such as Zanax and insulin. As long as everything is compatible, it will be ok. But, it sounds like most hospitals still require running TPN/Lipids in a seperate line.

[Nurseboy1]

At my facility we have a TPN team comprising of a physician, nurse and pharmacist. The nurse on the TPN team evaluates our patient's IV access and has to approve the IV site that we intent to use. Just the other day she rejected a patient's TLC because our resident had threaded a new catheter into the site over a wire. She was worried about infection.

But anyway, we can only give TPN through a central line.

[TriageRN_34]

I agree with the other posters...there have been rare occasions that we have had to run TPN/Lipids into a periph line, but that is if a central or picc couldn't be placed for some reason.

And at our facility...you don't mix anything in that line! If worse comes to worse...you either start up another peripheral, or you have to get permission to stop the TPN (or taper to a stop)by the MD, flush the line well...and give the next infusion you need to get in there...but that is avoided at all costs because that is not good to do with TPN! Stopping TPN isn't a good thing!

I have only seen that once..and it was for a vital blood transfusion and despite even x-ray placements of lines..none would stay! They had to give the blood badly....so this had to be done very carefully and over several hours just to slow the TPN to the point of being able to stop it. I still don't know why a central line couldn't have been done instead of all this...but the MD ordered what they did..and the pt was fine (not my pt!). I do know the picc lines that were tried wouldn't thread at all (post chemo pt).

[meownsmile]

The only TPN ive ever seen run into a peripheral line was WITHOUT lipids. The only thing ive ever seen piggybacked to run with TPN was albumin, and it ran as a piggyback and theTPN switched back over when it was over. Albumin used to be added to the TPN, but was stopped due to the speed of bacteria growth with it.

[superRN39]

At my hospital, in a rare occassion, we use PPN, which is TPN mixed specifically for a peripheral IV. Usualy the PIV is a midline. So yes, I have infused TPN through a peripheral IV, but it was specifically mixed for that. We would never run TPN mixed for a central line through a PIV.

We also run TPN and lipids together. The lipids and TPN are in there seperate bags, but we connect the lipids line to the TPN line after the TPN filter.

Some medications are compatible with TPN and lipids (we have a resource we look at to review which meds are compatble with TPN and lipids). For example, phenergan, octreotide, and flagyl (if I remember correctly) are compatible with TPN and lipids. You can use the TPN line to administer these meds if there are no other choices. On my floor we do this often.

[cardiacRN2006]

No! TPN must be run through a central line! Also, the only thing we can run with it is the lipids (below the filter).

No need to even think of other meds to run with it, since most central lines have more than one port.

[superRN39]

In addition to my post above - -

We often have patient's with multiple things running - for example, heparin gtt, D51/2 NS with KCL, insulin gtt, TPN/lipids, octreotide gtt - - so if we any have a triple lumen central line, we have no choice but to run things with the TPN/lipids!! Or sometime these patient's only have a double lumen PICC.