Question about PPN/IVP meds.

1. 0 Hi all,
   Scenario: Your Pt. has one peripheral line w/PPN going in. To give a med such as protonix via IV push, would I pause the pump, pinch the line above the port, flush, give meds, flush again, stop pinching & restart the pump? Or would one pause then disconnect & cap the pump/line entirely?

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2. 10 Comments

   Comment
3. 
   #1 1

   Sep 6, '12 by Asystole RN, BSN

   Correct answer is to start a secondary line.
4. 
   #2 0

   Sep 6, '12 by NewbieNeedsHelp

   Personally, I would pinch the line flush etc etc... Starting a new IV isn't efficient or necessary IMO...
5. 
   #3 0

   Sep 6, '12 by Asystole RN, BSN

   Quote from NewbieNeedsHelp

   Personally, I would pinch the line flush etc etc... Starting a new IV isn't efficient or necessary IMO...

   You would pause PPN, something that has a high rate of associated infection and complication, to push an IV med with a pH of 9-10.5 in a peripheral vein that already has a heavy infusate load?
6. 
   #4 0

   Sep 7, '12 by MunoRN

   Quote from Asystole RN

   Correct answer is to start a secondary line.

   I'm confused if you're referring to a secondary line or saying to start a new IV, those are two very different terms.
7. 
   #5 0

   Sep 7, '12 by applewhitern

   We never "push" protonix.
8. 
   #6 0

   Sep 7, '12 by halfpast

   Quote from applewhitern

   We never "push" protonix.

   In my hospital we started pushing last year. 40mg/10ml IVP over 2 minutes is standard.
   
   As far as the OP's question goes... Start a new peripheral IV. If not, when infusing meds you should prime a new set of tubing and disconnect the pt to infuse meds, although this is certainly not ideal. Get the best IV nurse that you have and get another vein cannulated.
9. 
   #7 0

   Sep 7, '12 by psu_213, BSN, RN

   Quote from applewhitern

   We never "push" protonix.

   I'm not sure who counts as "we," but at the hospitals at which I work, we push intermittent doses of protonix. There is also and continuous protonix gtt, but that is another story.
10. 
    #8 1

    Sep 7, '12 by psu_213, BSN, RN

    My first, question: is there a reason why this patient cannot get a central line? This would be the ideal situation--especially if they are going to get IV meds other than the PPN/TPN. If not, a second peripheral line for other meds would be the next best choice.
11. 
    #9 1

    Sep 8, '12 by iluvivt

    The best thing to do in this situation is to start another PIV and here is why. PN solutions are very complex and by nature are very prone to
    compatibility and stability issues. When you add another drug to these solutions
    you can further complicate the risk
    
    PPN can be given via a peripheral vein. The solutions when compared to TPN are more dilute with with osmolarity of 600 -900 mOsm/l, It is b/c of this the incidence or phlebitis is very high. Dextrose should not exceed 10 % and the osmolarity should be less than 900 mOsm/L in PPN.
    
    The use of PPN has become a bit controversial as the risk often outweighs the benefit. Often if the patient can benefit form PPN than they need TPN. I have not seen it used in many years now..we only use TPN and we always give centrally and usually through a PICC.
    
    Another thing to consider is also the infection risk would be higher especially if there are Lipids being infused as well. So in in this case by all means START ANOTHER PIV and monitor the PPN site carefully and rotate the site as soon as any complications develop.
12. 
    #10 1

    Sep 10, '12 by happyinillinois

    Protonix 40mg/10ml IVP over 2 minutes is standard everywhere I've ever worked.
    
    Start a new line.

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