CVL/PICC in NICU

[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

[ilstu99]

1. If you're using tubing with a cartridge, it stops releasing fluid when the pump stops. Think about when you're priming, and you open/close the valve on the cartridge to regulate the flow. Push the valve in, and the fluid stops. The valve is still pushed in when it's in the pump. No pump action...no flow. If you use a different kind of tubing, try explaining what you use, and maybe someone else has a good answer. :)

2. The alcohol dries, and the risk for contamination is nil. Just make sure you don't touch it again with dirty gloves before you connect them. If it makes you feel better, have everything ready to go, don't set the connector down between taking off the old one, cleaning it, and screwing on the new one. The luer lock system has a female and a male part designed to not allow air into the connection. I typically make sure the new fluid is overflowing a tad before I connect them. No worries.

[Jolie, BSN]

If you are concerned about free-flow of fluid from the old tubing into the baby (and you should be, as safety tubing can malfunction), you simply need to close the roller clamp on the old tubing. This is a basic safety measure that can and should be taken whenever you change out any kind of IVF thru any kind of line. If your tubing does not have a roller clamp, use hemostats or another kind of clamp to pinch off the line.