TPN and Lipids

Maybe she's thinking a PICC (since the P stands for peripheral)? Which, if that's what she's refering to, i'd wonder if she really knows what a PICC is.

Never heard of TPN and lipids going through a regular peripheral IV before either.

Lipids can be run through at peripheral line, though they usually arn't.

TPN, on the other hand, really must go through at central line. The osmolarity is too high for it to be given peripherally. It will damage the veins. This is a national standard, set by INS, the Intravenous Nurses Society. All nures who practice intravenous nurisng are held by these standards, no matter if they belong to INS or not.

There was a thread on this board recently about this very subject, and many posters stated that it was OK to give TPN peripherally, if necessary for a short time. This is not the case, as it violates national standards. Even if your hospital policy states it is OK, that won't stand up should a lawsuit come about. If a pateint is receiving TPN and lose their central access, the proper procedure is to hang d10 until central access can be re-established.

Now, PPN is different. PPN (partial parenteral nutrution), such as Quick Mix, is OK to put through a periperal line, though the line probably won't last very long. Maybe this is what the educator was talking about? Or, the educator could have been referring to PICC lines, which many people consier to be peripheral lines. They are not. PICCs are central lines. Even though the line starts in the arm, it end in the vena cava, just like any other central line. So TPN can go through piccs.

The Infusion Therapy textbook put out by INS states:
"The low osmolarity of fat emulsions permits delivery by peripheral veins."

It later states:
"peripheral venous access for PPN ... , should be limited to short-term or supplemental therapy especially if PPN does not provide the patien't nutrient requirements. TPN solutions require access into a central vein to allow rapid dilution of the solution to prevent phlebitis, pain, and thrombosis."

Critter lover is right....NO TPN PERIPHERALLY...
I wouldn't want to even infuse lipids into an arm vein....it's just asking for phlebitis...
get a central line in....
Your instructor is wrong.

Hi,

Saw the post and thought I would respond. I am a NICU nurse. We OFTEN run TPN, lipids through a peripheral IV---you just have to make sure the dextrose content is not above 12.5%, and we don't run TPN with calcium in it into a PIV, we would give IV pushes of calcium. I will say PICC lines are very nice because you can give a higher dextrose content and have calcium in it---provided the line terminates centrally and isn't a "deep PICC"....hope this helps.....

THE KEY IS THE DEXTROSE PERCENTAGE, as SFRN points out. The rule at my old hospital was that if dextrose was >10%, then it must be given through a central line.

PPN keeps dextrose at 10% or lower, so it can be given peripherally (as Critter Lover mentions above).

THE MAIN PROBLEM IS WE USE THE TERM "TPN" FOR BOTH TPN & PPN. That's what causes the confusion, I think.

Thanks for this great conversation!