What is wrong (if any)with this picture?

xtxrn, ASN, RN · Jul 25, 2011

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. :uhoh3: 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.... :mad:

Esme12, ASN, BSN, RN · Jul 25, 2011

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.

Selene006, BSN, LPN · Jul 25, 2011

Aaaaaaaaaaaagh! How long did you stand there and gasp?

tokmom, BSN, RN · Jul 25, 2011

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. :lol2:

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. :rolleyes:

xtxrn, ASN, RN · Jul 25, 2011

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

OMG.... :nono: :smackingf:no:

ChristineN, BSN, RN · Jul 25, 2011

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.

xtxrn, ASN, RN · Jul 25, 2011

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- :uhoh3: ). "It was the same color".... Yikes. :eek:

tokmom, BSN, RN · Jul 25, 2011

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.

:eek: :eek:

RNChristy · Jul 25, 2011

That is just scary that the nurse didn't know any better!!

Christy

tokmom, BSN, RN · Jul 25, 2011

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.

xtxrn, ASN, RN · Jul 25, 2011

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 !!