TPN questions

suzanne4, RN · Jan 24, 2006

The reason that some facilties do not add insulin to the TPN , especially in some NICUS, is that the baby's needs are constantly changing. The TPN goes up for 24 hours, and would be very expensive to have to keep changing it during the day. Much easier to have is separate for that case.

Gompers, BSN, RN · Jan 24, 2006

The reason that some facilties do not add insulin to the TPN , especially in some NICUS, is that the baby's needs are constantly changing. The TPN goes up for 24 hours, and would be very expensive to have to keep changing it during the day. Much easier to have is separate for that case.

This is true, those sugars are usually all over the place! So we never have the insulin actually added to the TPN bag - it's always a separate drip. I think there have been cases where we've run it together into the same line with the TPN, it's just that usually we put it through a PIV.

BittyBabyGrower, MSN, RN · Jan 24, 2006

Same as Gompers....even our peds floors run TPN thru peripherals if there is not central access. You can run up to D12.5 thru a peripheral.

The insulin goes by itself or IVPB with HAL....you may need to titrate the drip or turn it off, so you wouldn't be able to do that if it was in the HAL.

We draw labs thru the central line as long as it is okayed with surgery...sometimes they are placed in a smaller vessel. We draw back 3-5 mls and get our labs. Then we put back the blood we took out.

We piggyback a lot of things with the HAL, but there are a few things that have to run alone.

fergus51 · Jan 24, 2006

Interesting to hear. We do run it as a separate drip on those wacko sugar babies, but the vast majority I've had with insulin in the TPN do just fine. I can only think of one time in the last 2 years we've had to change the TPN early because the sugars were out of wack. Usually, if the sugars are wacky, they will just decrease the TPN rate and Y in another line (of lower or higher dextrose depending on the need), but of course this is dependent on the other electrolytes being normalish.

LilRedRN1973 · Jan 26, 2006

I'm doing a little research on TPN policies and have some questions:

1. Do you give TPN via a peripheral line ever? (PPN)

*We will give in peripheral if it's PVN, but TPN never goes into a peripheral, only a central. Tubing is changed Q shift, along with the port and filter.

2. Do you always stop the TPN for lab draws (even if the TPN is in a central line and the draw is peripheral?)

*Stop TPN, flush, draw 10ml waste, then draw my labs.

3. Do you add insulin to the TPN for elevated blood sugars or do you run a seperate insulin drip?

*Pharmacy adds insulin to our TPN and adjusts daily, according to patient's needs. We then put the patient on QID FSBS and have a sliding scale coverage.

4. Do you infuse other meds into a line that has TPN running in it?

*Our TPN contains Mg, Phos, lipids, insulin, pepcid, multivitamins, and various other things. We check it against the printed order to ensure that everything is correct. We are not allowed to piggyback or add anything else to a line with TPN. It must be a dedicated pump/line.

Melanie = )

peds77 · Jan 28, 2007

Can you give Lipids via a PIV?

seeandwhy · Jan 28, 2007

We only give TPN via central line because all patients in my floor has a central line and we do not stick our patients therefore no peripheral lines. We draw our blood works twice in 24-hour period and we usually clamp the TPN line then draw blood from another line but the first 10cc is to be discarded because then we draw our sample. We also give meds to the TPN (of course compatibility of the meds is a priority). Usually,we have TPN in 1 line, then lipids in another line, then either tacrolimus or cyclosporin in another line, sometimes w/ PCA in another - all of these goes in 1 lumen of any kind of central line access.

Klohmann330 · Jan 31, 2011

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'mANurse! · Feb 1, 2011

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 :)

BabyLady, BSN, RN · Feb 2, 2011

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.

ChristineN, BSN, RN · Feb 2, 2011

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.