TPN Tubing Change - page 2

by donnuchi

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How frequently is your tubing changed for TPN? If you change it every 24 hours, is your lipids mixed in with the TPN? We currently change our tubing every 72 hours. The lipids are separate and we change that tubing every 24... Read More


  1. 0
    Quote from RNjbpltp
    Also, they are NEVER mixed, as the TPN requires a filter and you cannot filter lipids.

    I'm not sure why TPN and lipids are always separate but I'm pretty sure it's not because lipids can't be filtered. TPN and lipids are routinely mixed in the same bag in the adult world. There is a special filter that is used just for the TPN mixture (sometimes called 3 in 1 mixture for amino acids, dextrose and lipids).

    I thought they were separate to make it easier to give IV meds because so many more meds are compatible with the amino acid/dextrose mixture and aren't compatible with the lipids. Some cancer patients that only have a single lumen PICC get their lipids bolused over 4hrs so other IV meds can be given in the same line as their TPN the rest of the day.
  2. 1
    Quote from TiffyRN
    I'm not sure why TPN and lipids are always separate but I'm pretty sure it's not because lipids can't be filtered. TPN and lipids are routinely mixed in the same bag in the adult world. There is a special filter that is used just for the TPN mixture (sometimes called 3 in 1 mixture for amino acids, dextrose and lipids).

    I thought they were separate to make it easier to give IV meds because so many more meds are compatible with the amino acid/dextrose mixture and aren't compatible with the lipids. Some cancer patients that only have a single lumen PICC get their lipids bolused over 4hrs so other IV meds can be given in the same line as their TPN the rest of the day.
    Another reason they're separate in the NICU is because babies can only get so much lipids per day or their triglycerides will be all over the place. However, most of us use the hyperal as the maintenance fluids for the baby, and if fluid volume needs change, this is the IV that we increase or cut back on. If the lipids were mixed in, we'd be screwing up how much lipids the baby gets per day by changing the rate around.

    The only time I've seen them mixed together was in home care. The babies who go home with Broviacs and TPN have these IV bags and tubing that have NO AIR in them, so either there is no filter for bubbles or if there is a filter, it's okay for lipids, I forget because it's been a couple of years since I've worked with one of these set-ups. The bag is kind of cool - it is a huge flat IV bag that has hyperal on one side and lipids on the other, separated by a plastic clip. Each day, the mom takes a new bag out of the fridge and pulls the plastic clip off, and then the hyperal and lipids mix together. She primes new tubing and runs it through a small IV pump, the puts the pump and bag into a small backpack, with just the tubing running to the baby. It's smaller than the apnea monitors, even!
    Last edit by Gompers on Aug 15, '06
    cassiehawk likes this.
  3. 0
    q24 hours at my home hospital, bags and lines

    My clinical hosp that I was just at would allow q72 changes if no lipids and it was a bag that wasn't messed with by pharm. (like plain d10W)

    As soon as it has a pharm additive though, it's q24 for everything.
  4. 0
    We run TPN and Lipids through different infusion sets.....y-site them. Can't run the lipids through the TPN filter because it is a small micron filter...filters out the large lipids. Lipids can be filtered, but it is a larger micron filter designed especially for lipids. Infusion sets for lipids are changed with each bag...you have to d/c the set when the lipids are infused. TPN infusion sets are changed q 24 hours.
  5. 0
    There is nothing wrong with lipids and TPN running thru the same line. Connect the lipids to the TPN line below the filter. Lipids are too large to got thru the filter.
  6. 0
    TPN tubing changed every 72hrs, unless drastic glucose, protein or lyte concentration changes which warrants tubing change with that TPN. TPN tubing may need to be changed sooner when/if high glucose or calcium clogs the filter. Lipid tubing is changed every 24hr when new lipids are hung. TPN/IL is hung under sterile technique if infusing via central or PICC lines. This has been my experience at 2 different NICU's.
  7. 0
    POLICY is all TPN and IL tubing changed q24, but reality is IL changed q24 and TPN changed depending on flow rate - <10cc/h is changed q24, >10cc/h is changed q72. They're drilling into all us new orientees (yay!) that we better do it q24.
  8. 0
    Everything is changed q 24 in my unit, except for the premixed bags. I understand there is an issue with lipid breaking down the plastic tubing if allowed to hang to long, so it's a q 24 hour change also.


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