Infusing TPN - page 5

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... Read More

  1. by   Tweety
    Originally posted by ceecel.dee
    Patients needing IV access for "weeks on end" are the indication for the central line, in many cases. Our infection rate remains nill.
    I'm talking about patients who have theirs in 3 weeks or longer, who are generally very ill. I think that is a long time for a central line, but definately not unheard of.

    I'd like to say our infection rate is nil, but that's just not true. But it is pleasantly low.

    So what is the average life of a central line? I've always assumed it was for the short-term (several days to several weeks). That port-a-caths, Groshshongs, etc. and others for for the "weeks on end" people.
  2. by   gwenith
    Tweety

    http://www.joannabriggs.edu.au/pubs/cvl.php

    You might find this helpful unfortunately I could not find anything on frequency of catheter changes. I have a feeling I have read a systematic review on it though - maybe the Cochrane database??
  3. by   caroladybelle
    As a matter of note.

    All CVADs should have a blood return. If they do not, frequently it means that either they are not in the right place (and should be replaced/or repositioned by MD), or fibrin sheathes/clots have formed. In addition, ports develop "sludge" in them. If you ever see one removed, they have really nasty looking crud in them.

    All of these predispose the patient to develop line sepsis, despite good technique. Bacteria in the body or introduced from the line will feed on the clot/fibrin/sludge. Also the clots/fibrin irritate surrounding tissues, predisposing them to more clots and complications.

    As such, if lines do not draw blood return, and placement has been confirmed by IR, they should be declotted if possible, to decrease risk of complications. This is the policy of the Oncology Nurses Society. As well as chemo (especially vesicants/irritants) should never be given through a line that has no blood return.

    Some surgeons are notorious for placing lines that do not have return. And others are almost perfect in their placement and usefulness. It can be very difficult to get them to use better technique. Fortunately, I have been fortunate to work with Oncos that require good technique/placement and refuse to work with surgeons that have poor technique. The Oncos are adament about excellent care for their patients and that they not be stuck more than absolutely necessary and that risk of infection and complications are minimized.
  4. by   nowplayingEDRN
    Check out these links that I used when developing my CVAD inservice.

    http://www.meditheses.com/997-962.htm

    http://www.nursingcenter.com/prodev/...asp?tid=260258

    http://www.nursing-standard.co.uk/ar...fs/4550w43.pdf

    I hope that these provide some good valuable info for folks to use and incorporate into their practice combined with the follwing of their individual facility's SOPs.
  5. by   Tweety
    Thanks Gwenith for the interesting link. But I was asking how long the line itself should stay in.

    According to an article in UntamedSpirit the untunneled lines CVAD lines, which is what I'm talking about, no standard has been set as to how long they stay in.

    But from my experience, the longer they are in, the higher the risk of infection, which is kind of like "well duh...of course".

    Just was curious how long is too long.
  6. by   NRSKarenRN
    Had homecare patient with triple lument CVP in for ONE YEAR before we could find a doc willing to replace it. Only two RN's did the dressing changes , no infection. Rule of thumb in Philly area is to get non-tunneled caths replaced q 2-3 months for home infusion patients.
  7. by   nowplayingEDRN
    Originally posted by 3rdShiftGuy
    Thanks Gwenith for the interesting link. But I was asking how long the line itself should stay in.

    According to an article in UntamedSpirit the untunneled lines CVAD lines, which is what I'm talking about, no standard has been set as to how long they stay in.

    But from my experience, the longer they are in, the higher the risk of infection, which is kind of like "well duh...of course".

    Just was curious how long is too long.
    I know I have read something about dwell time recommendations, as Gwenith has mentioned. Now, the problem is remembering where I read it. I am either: A) getting old, B) developing Alzheimers at an early age or C) just plain suffering from CRS syndrome!!!
  8. by   New CCU RN
    Originally posted by P_RN
    I guess this goes with beating a dead horse, but I still want to read the policy from the #1 cancer treatment center. Passing- thru where can it be found?

    Passing thru.........why dont you pass on through and answer everyone's question???? Please enlighten those of us not fortunate enough to be employees of a world class hospital.
  9. by   RedWeasel
    Quote from SharonH, RN
    As it has already been pointed out, many meds can be piggybacked throught the same line as Hyperal but it is the Lipids which are incompatible with other medications. If you only have one one lumen on your central (or peripheral) line for whatever reason, you simply need to shut off the lipids, flush the line real well, and you can run most anything with the Hyperal. If you are using a pre-mixed bag of Hyperal/Lipids together, obviously that cannot be done. If you have more than one lumen, it is preferable to simply run your other meds through the other lumen.


    Edited to add: The Hyperal should not be interrupted due to the risk of hypoglycemia so you should take care as to how you secondary meds are run with it.






    That's pretty sad. The overwhelming majority of nurses I work with are simply too professional to be so sloppy and careless.Yes, there will always be an exception because we are human. It sounds like these people dropped the ball. They needed to re-educate their nursing staff instead of simply making allowances for gross incompetence leading to discomfort for the patient.

    yeah! true I have never seen a nurse replace an old cap, or not wear a mask-or have the pt wear a mask. Use sterile gloves....I suppose it could happen but when you even go to change the dressings everything is in a kit at our place. If everything is provided for, how can you be sloppy, right? We know how easy it is to get, say, a PICC clotted off...pts with SDHs or cranis who aren't on anticoagulants are famous for it on our floor. Our orders say to flush at least q 24 hours. We know if it isn't flushed every shift it will most certainly clot off and then it is alteplase city! Which takes a long time to work. I think it goes back to orientation of nurses to a facility and continuing education, and just communication between coworkers-don't be afraid to ask each other questions....when in doubt don't chicken out--better to look a little uncertain now (ask does the pt have to wear a mask too?--even if you asked the same question last month) than to look really dumb later when you have been caught changing a dressing while the pt is coughing maskless onto the site, who later on comes down with a nice 104.0 temp....and when the PICC is pulled there is yellow stuff on the end...and when pp ask you 'dumb' questions don't treat them dumb-I just see more and more lately they forget how many questions they asked when they first started (I should take notes)...going to bed I ramble...
  10. by   Imafloat
    We have a compatibility chart for patients on HAL/IL I was surprised to learn that Ampicillin isn't compatible with HAL, it can form crystals. We have always given Amp with HAL. We don't directly piggyback into the HAL line, we have a trifuse with a safety care for meds, HAL, and IL.

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