Cvl/picc Help Please!

[ace.happy]

Hello everyone I am new in the NICU and have some questions about CVL/PICC. If anyone could help or direct me to a website I would really appreciate it! I have spent hours online trying to find a direct answer but I didn't have any luck.

1. At our facility we have change the TPN/Lipids tubing Q 24H, the way I have been taught is after I have primed my new TPN/L tubing and have it hanging ready to go, I pause the pump on current TPN and channel off the Lipids, and remove the current TPN/L from the pump, place the new TPN/L in the pump, set the rate and start it, then I disconnect the old TPN/L from the patient, clean off the hub and place in the new running TPN/L. What I don't understand is when I take the old TPN/L out of the pump, I still haven't disconnected this from the patient, doesn't that mean that the old TPN/L is still infusing into the patient and at what rate, since I haven't clamped anything off and the rate is no longer regulated by the pump (and it takes a little time to put in the new tubing in the pump and program in the new rate/TPN and rate/dose/amt for Lipids, Im still new so I am really slow). I just don't understand this and I cant get an answer from anyone, I'm really worried that I am doing something wrong!

2. On a CVL mainly broviacs the process is the same, except that the connector or adapter leg is white and appears different that on a PICC. When we change the tubing we change everything down to the connector (I think the connector is called the luer lock that attatches to the 3 Lumen TPN/L/Saline filled lumen) that connects to the white adapter leg. What worries me is the same as above, and another concern is I clamp off the CVL when I am taking off the old tubing, then I am to clean the connector with alcohol then attach the new running tpn.lipids, but when I am cleaning with alcohol and the connector is exposed to air, isn't there exposure to air and then I am attaching the new tpn/l, could I be pushing air into the line then??? I'm really confused, if anyone could clarify this for me I would really appreciate it, sorry if I am using the wrong medical terms or leaving something out!

Please help, Thank-you!

[PICC ACE]

RE #1-After you have primed your new tubing with the TPN,use the roller clamp on the line to clamp the tubing. When you remove the old tubing from the pump,it is probably designed in such a way as to prevent free-flow of the fluid upon removal,but you should use the same roller clamp to clamp the line as well for added security. Swap lines,being sure to disinfect the connection thoroughly,undo the roller clamp on the new lilne and resume the pump. Might take a time or two to get comfortable with the process but its not so hard.

RE #2: All Broviacs I have seen have a clip-style clamp on the external part of the catheter. This to prevent the very thing you are worried about,to wit air in the line. Any time you need to unhook a line from a Broviac you should engage the clamp on the line,then do your unhooking,cleaning and reattachment procedures. Just remember to undo all those clamps--if you don't,you'll be back in the room in a few minutes when the pump beeps for an occlusion alarm.

Good luck to you.