I work in ltc and...

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    We are going to start accepting pts on tpn.... I have been an RN for 2yrs, nervous about it. Word is we can get picc line certfied on-line. Question is, has anyone done it this way before? Or would you?
    Thank you for your response!
  2. 14 Comments so far...

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    I'm not crazy about the idea. I think return demo/skills checkoffs are an important part of the process. How will you do that online?
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    I'm not sure how this will work either. I'm skeptical about doing it this way. I also made sure they knew I was not going to do it unless they get pumps. I will not do it to gravity...
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    Am I wrong telling them that?
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    I meant, am I wrong for telling them that?
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    Not to come across as a smart aleck, but didn't you learn central line care in school? We covered all this in school, and I didn't get any extra training when I started at the hospital. I understand needing a little refresher training if it's been a couple of years, but surely you must have covered the material before, so on online refresher should be adequate. I agree, I would want it run on a pump as well. Really most IV's should be on a pump when it's possible. If it's gravity feed, and it stops, it tends to clot off lines. If a pump stops, it alarms you immediately.
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    your pharmacy should come out and do a training before you get your first TPN patient.
    kids and ~*Stargazer*~ like this.
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    Unless I'm wrong (but I don't think I am), TPN is ALWAYS, ALWAYS run on a pump R/T potential for unbelievable danger of a runaway infusion. For this reason, personally I would never do TPN without a pump. Also something to keep in mind about your med room --- you'll need a BIG refrigerator for those huge bags, and it needs to be CLEAN (that means, no staff clothing, rainy umbrellas, dirty boots, boxes of briefs and blue pads, pizza boxes, etc. Your technique and environment for TPN must be top notch for infection control. And make sure your place has plenty of IV poles. The poles used for enteral feedings are frequently less than pristine, so having a fleet of sturdy clean poles is a must. You'll also want to have sufficient glucometer equip. And since your LTC facility is new to TPN, a CEU-type course on its management would be a good idea. Also, there are courses on PICC line mgt (the do's and don'ts kind of stuff --- I don't think you were talking about insertion as that's not online.
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    No, you're not wrong. TPN needs to be on a pump.

    I imagine the patients will have their PICC lines inserted while in the hospital, and you will be responsible for line maintenance after discharge. The keys for maintaining a PICC are infection control and maintaining patency.

    For infection control, you'll need protocols for proper hub scrubbing, cap and dressing changes, tubing changes, and medication storage. For maintaining patency, flushing protocols and de-clotting protocols need to be in place.

    "You learned central line care in school" is not good enough. Your facility needs to have policies, procedures, and protocols in place. This is both for the protection of the patients and the nursing staff.

    You are not wrong to tell them "No" if they want to push this on you without proper training and education, and implementation of P&P.
    Last edit by ~*Stargazer*~ on May 11, '12
    Chris81 and wooh like this.
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    Thank you, Stargazer, for the additional reminders. It's been a while since I've done TPN as not all facilities in my area do it. Some very practical info here. One last thing ... the facility will need a strong contract with its laboratory services providers R/T all the frequent lab values needed.
    ~*Stargazer*~ likes this.


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