What is wrong (if any)with this picture? What is wrong (if any)with this picture? | allnurses

What is wrong (if any)with this picture?

  1. 0 You come on shift and have a pt with a triple central line. Looking at the IV bags, you see a routine IV bag hanging. Your eyes shift to the TPN and Lipids that are infusing. The Lipids are the primary IV solution. The TPN is piggybacked with the filter above the pump mechanism and then the two run in together to the patient.
    Last edit by tokmom on Jul 25, '11
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  2. 36 Comments

  3. Visit  xtxrn profile page
    #1 0
    Quote from tokmom
    You come on shift and have a pt with a triple central line. Looking at the IV bags, you see a routine IV bag hanging. Your eyes shift to the TPN and Lipids that are infusing. The Lipids is the primary IV solution. The TPN is piggybacked with the filter above the pump mechanism and then the two run in together to the patient.
    Oy. Ok, I'm rusty, but I'd be hacked off about finding this.....was the pt ok?

    So however much of the TPN happens to get into the lipids, that's what the pt gets.... no way to know. (so the insulin in the bag- usually there- is also going in at ? rate).

    Med error paperwork, get ready....
    Last edit by xtxrn on Jul 25, '11 : Reason: clarify
  4. Visit  Esme12 profile page
    #2 6
    In my vision....the Lipids should be the piggy backed med. The TPN should be the main line with the filter below the pumping mechanism and the lipids piggy backed into the TPN below the filter.......IF you piggy back at all. If you have 3 lines open why not use all three?????

    Does your facility have a policy requarding a designated TPN line/port? Some places do and NOTHING is placed in the port or used by the port unless the patient is coding. and EVEN then that's debatable....

    I'd be pretty astonished to find this and I would report it and talk to the nurse to find out what she/he was thinking.
  5. Visit  Selene006 profile page
    #3 1
    Aaaaaaaaaaaagh! How long did you stand there and gasp?
  6. Visit  tokmom profile page
    #4 3
    I didn't find it. A coworker sent me a scathing text at 0630 this morning who was really ****** off. Even in my sleepy haze it I knew why she was so mad.
    Evidentally she was taking over for a nurse who needed to leave early. The night nurse said she was told to do it this way because....(drumroll of stupidity).....they didn't want to have another IV pole in the room! So...they piggybacked everything like they did and then put the pca pump and maintenance pump down below. My friend fixed it and then filled out the paperwork which really ticked off nightshift. They wanted evidence based practice on why you can't run lipids so high up in the line. We both remembered something about bacteria forming because of the high glucose content. If run lipids near the end, it has less chance of becoming contaminated.

    Yes, we do have policies and this was not what it stated. I have also found PCA's piggy backed into the TPN line.
    Last edit by tokmom on Jul 25, '11
  7. Visit  xtxrn profile page
    #5 0
    Quote from tokmom

    I have also found PCA's piggy backed into the TPN line.

    OMG.... :smackingf
  8. Visit  ChristineN profile page
    #6 4
    Quote from xtxrn
    Oy. Ok, I'm rusty, but I'd be hacked off about finding this.....was the pt ok?

    So however much of the TPN happens to get into the lipids, that's what the pt gets.... no way to know. (so the insulin in the bag- usually there- is also going in at ? rate).

    Med error paperwork, get ready....
    Some places do mix TPN and Lipids into one bag, and not all places put insulin into the TPN. However I have never heard of running one as a piggyback.
  9. Visit  xtxrn profile page
    #7 1
    Quote from ChristineN
    Some places do mix TPN and Lipids into one bag, and not all places put insulin into the TPN. However I have never heard of running one as a piggyback.

    Yeah, the hospital I worked at went to combined TPN and Lipids (which was nice- less hassle). Another uh huh- never heard of the piggy back method, either

    The worst thing I heard about with central lines is some nurse giving Maalox IV into a subclavian.... needless to say, heartburn was never a problem again.....:smackingf Another genius (same hospital) thought that the TPN and Foley bag were directly related (fortunately there was no way for her to act on her brilliant deductions- ). "It was the same color".... Yikes.
  10. Visit  tokmom profile page
    #8 0
    Quote from xtxrn
    Yeah, the hospital I worked at went to combined TPN and Lipids (which was nice- less hassle). Another uh huh- never heard of the piggy back method, either

    The worst thing I heard about with central lines is some nurse giving Maalox IV into a subclavian.... needless to say, heartburn was never a problem again.....:smackingf Another genius (same hospital) thought that the TPN and Foley bag were directly related (fortunately there was no way for her to act on her brilliant deductions- ). "It was the same color".... Yikes.
  11. Visit  RNChristy profile page
    #9 3
    That is just scary that the nurse didn't know any better!!

    Christy
  12. Visit  tokmom profile page
    #10 1
    Quote from xtxrn
    Yeah, the hospital I worked at went to combined TPN and Lipids (which was nice- less hassle). Another uh huh- never heard of the piggy back method, either

    The worst thing I heard about with central lines is some nurse giving Maalox IV into a subclavian.... needless to say, heartburn was never a problem again.....:smackingf Another genius (same hospital) thought that the TPN and Foley bag were directly related (fortunately there was no way for her to act on her brilliant deductions- ). "It was the same color".... Yikes.
    The lipid PB is all I know. I have never seen one with lipids and TPN combined. If this is the case, then is the lipids causing bacterial growth in the tubing, hence it being PB's so low in the tubing, really just an outdated theory?

    ETA: We change our lipid tubing Q 12 hrs and our TPN Q 24. I guess we would change the tubing Q 24 with a combined mixture.
  13. Visit  xtxrn profile page
    #11 2
    Quote from RNChristy
    That is just scary that the nurse didn't know any better!!

    Christy
    Yep... those were two legends of that hospital, and drilled into the heads of all new nurses, no matter how much experience they had.

    Need a smiley that's shivering in fear !!
  14. Visit  Tait profile page
    #12 1
    Generally on a triple lumen we don't run anything on the middle port. Most patients have a double so we do IVF, meds, PCA's, abx on one port and TPN/lipids on the other. Filter on TPN at the end of the line, closest to the patient, lipids on a separate pump run into the TPN below the filter. Line change on TPN/lipids Q24 at 6pm. Lipids tend to be cyclic 6p-6a so I guess that makes the line changed Q12.

    Sounds like a bit of a mess, and I guess you will have to hit up the pharmacy or nurse educator for support/evidence/policy.

    Best of luck!!

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