TPN questions - page 3

by Celia M 34,301 Views | 22 Comments

I'm doing a little research on TPN policies and have some questions: 1. Do you give TPN via a peripheral line ever? (PPN) 2. Do you always stop the TPN for lab draws (even if the TPN is in a central line and the draw is... Read More


  1. 0
    Quote from Klohmann330
    Help!


    I'm currently taking my IV competency review and one of the questions asked which kind of insulin would be added to TPN for continued Hyperglycemia... multiple choice answers included Novolin 70 30, NPH, semi-lente, and regular humulin

    My guess is regular humulin but we don't mix in insulin to tpn where I work so this is a new concept to me!
    Any ideas?

    I don't work with insulin much, but I do remember that there is only one type of insulin that can be given the IV route! Hope that helps
  2. 0
    Quote from Gompers
    Well, I work in the NICU, and our babies usually have pretty limited IV access. Most of the time we have peripheral IVs, PICC lines, and umbilical catheters. Once in a great while, we'll have an older baby with a Broviac line. But we do give TPN daily to about 50% of our patients, so I'll join in...

    1. Yes, we give it peripherally. The dextrose has to be 12% or less, and the protein levels are lower as well. Usually this is a case where it's a new baby who hasn't had a PICC line placed yet, or a baby who did have a PICC line that got infected, and we won't typically place a new PICC until blood cultures are clear.

    2. In the rare case that we have a Broviac, we'll stop the TPN, flush the Broviac, draw off 3cc of blood and then draw the labs. However, we never draw glucose or electrolytes off a line that had any dextrose/electrolyte solution running throough it. Otherwise, we'll draw the blood elsewhere while the TPN continues through the PIV, PICC, or UVC.

    3. We always start a separate line for insulin drips and run it by itself.

    4. We infuse whatever we can with the TPN! Again, limited IV access. According to pharmacy, NOTHING is compatible with TPN, but we have published charts that show what is actually compatible at the Y-site. If it's okay there, better believe we're going to use that line! We never have double lumen lines if it's a PICC, only if it's a UVC.
    I second this.

    We have a Neofax that tells you every drug that you can infuse with TPN as well as Lipids...both solution and site compatability.

    However, on a side note, our TPN and the entire tubing (at least in our unit) is changed on a daily basis.
  3. 0
    Quote from Celia M
    I'm doing a little research on TPN policies and have some questions:
    1. Do you give TPN via a peripheral line ever? (PPN)
    Sometimes. I personally hate giving it peripherally, as I have had some nasty infiltrates. However, my facility does allow it, provided the Dextrose concentration is less than 12%
    2. Do you always stop the TPN for lab draws (even if the TPN is in a central line and the draw is peripheral?)
    Wow, good question!! I typically don't stop the TPN for peripheral draws, but I do stop it for central draws and make sure I have at least a good 10cc discard.
    3. Do you add insulin to the TPN for elevated blood sugars or do you run a seperate insulin drip?
    I've done adults and peds. I've noticed in adult care they tend to be more willing to add insulin to the TPN, especially for diabetic pts. I have never seen insulin added to TPN for peds pts. Also, I have seen Zantac/Protonix added to the TPN bags.
    4. Do you infuse other meds into a line that has TPN running in it?
    Absolutely. If you are unsure of which meds are compatible with TPN ask your pharmacist or look in your drug guide. Some meds are only compatible with TPN and not with Lipids, or vice versa.


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