What is wrong (if any)with this picture? - page 4

by tokmom 12,933 Views | 36 Comments

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... Read More


  1. 0
    I guess if they are all in the same bag they could go into the same line, but I still wonder about the filter...
  2. 1
    Quote from tipsplease
    before even reading any of the responses on this, here is the bottom line as far as I am concerned: TPN and lipids, like blood, should always be administered separately. Lipids don't need a filter, TPN does. The tubing has to be changed every 24 hours.

    Some things never change. If for no other reason not to run lipids and TPN together, one needs a filter, the other does not.

    TP
    As others have stated, TPN and lipids are frequently all mixed together in ONE bag.

    TPN and lipids can be run together, the TPN gets a filter, the lipids are connected to the port below the filter.
    dbscandy likes this.
  3. 0
    thanks for the heads up. I did interventional cardiology for a long time; never really worked with this stuff until recently. I am learning so much by going back to med-surg!
  4. 0
    I always ran the Lipids primary thru pump into central line port. The Lipids ran on a seperate pump, but was piggybacked into the Lipids at the final port that was proximal to the patient, but distal to the filter. I used silk tape and clearly labled the TPN line and the Lipid Line with med/date/time/initials to prevent someone from inadverdantly disconnecting or trying to push a drug, run an IVPB, etc. I would typically use the white port on the TL for this. I would also try and use a double pump and would also place a tape lable near the door lock listing the TPN and Lipids and would activate the lock out on the back of the pump to prevent someone from accidentaly changing the rate.

    If I had IVF, PCA, etc. I would try and utilize the Blue port for these, and attempted to keep the red port patent for blood draws. It would always amaze me the IV tubing spaghetti I would find at the beginning of my shift, or the multiple piggybacks into a single IV line.
  5. 1
    Quote from tipsplease
    I guess if they are all in the same bag they could go into the same line, but I still wonder about the filter...

    Adding the lipids to the main bag to infuse in 24 hours makes the lipids dilute enough the filter isn't a problem.
    dbscandy likes this.
  6. 0
    Quote from tipsplease
    thanks for the heads up. I did interventional cardiology for a long time; never really worked with this stuff until recently. I am learning so much by going back to med-surg!

    Exactly the reason instructors/other nurses recommend a year or two of med-surg after school It't almost a continuation of nursing school while stuff is still fresh Interventional cardiology must have been a lot to learn as well- the procedures they can do now is pretty amazing
  7. 0
    Quote from clhankin67
    I always ran the Lipids primary thru pump into central line port. The Lipids ran on a seperate pump, but was piggybacked into the Lipids at the final port that was proximal to the patient, but distal to the filter. I used silk tape and clearly labled the TPN line and the Lipid Line with med/date/time/initials to prevent someone from inadverdantly disconnecting or trying to push a drug, run an IVPB, etc. I would typically use the white port on the TL for this. I would also try and use a double pump and would also place a tape lable near the door lock listing the TPN and Lipids and would activate the lock out on the back of the pump to prevent someone from accidentaly changing the rate.

    If I had IVF, PCA, etc. I would try and utilize the Blue port for these, and attempted to keep the red port patent for blood draws. It would always amaze me the IV tubing spaghetti I would find at the beginning of my shift, or the multiple piggybacks into a single IV line.
    Lipids were primary, and lipids were piggybacked into lipids?


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