Designated port for PPN/TPN

[2shihtzus]

I had a patient with a triple lumen central line who had PPN infusing. Anesthesia wanted it disconnected before the patient went to surgery so we disconnected it and flushed the line. The nurse in PACU wanted to know which port (red, white, or blue) it had been infusing in because she said that once TPN/PPN is initiated, it has to stay in the same port for the duration of therapy.

I have never heard of this. Any input?

[SwansonRN]

Yes. TPN always needs it's own lumen that is only used for the purpose of infusing TPN. No other meds, no blood draws. I always put some sort of label on the lumen so that everybody else knows its reserved.

[2shihtzus]

What is the rationale behind it? I mean I know that once it is infusing, it is a designated line; nothing else should be placed into it. But if its disconnected and flushed, shouldn't it be ok to switch lumens?

[Tait, MSN, RN]

Sounds like it is primarily infection reduction because the TPN solution also provides a good growth medium. Less access, less risk for bacterial introduction, less infections.

http://books.google.com/books?id=E0fA9G-meIkC&pg=PA299&lpg=PA299&dq=rationale+behind+a+designated+TPN+lumen&source=bl&ots=qtPk006oQn&sig=Wa8H6WsV39GUDjOlaYZdhcXUpS0&hl=en&sa=X&ei=4yGkUdq1E4iS9gSg_4DIBQ&ved=0CDMQ6AEwAw

[2shihtzus]

I wonder if the same applies to PICC lines? There are no proximal, medial, or distal ports.....?

[amoLucia]

Like PP says, it sounds like it is to preserve the port's integrity for future TPN use. That and the infection risk. That that port would be used as a last resort sounds reasonable to me.

[K+MgSO4, BSN]

I wonder if the same applies to PICC lines? There are no proximal medial, or distal ports.....?[/quote']

Yes choose a line and stay with it. TPN has a high glucose content so is a huge risk for bacterial growth. Also the line can become "sticky" altering the delivery of other drugs. Ever made TPN up? Rolling the bag to break the compartments was a huge risk of getting covered in sticky stinky fluid requiring a clothing change.

[classicdame, MSN, EdD]

Also, if you have dedicated ports for TPN then if it clogs up you can still give meds and blood and find another route for nutrition. Might be a life-saving measure at some point.

In our facility, red port is for blood, white for nutrition and blue for fluids. If fewer than three ports we must label.

[KelRN215, BSN, RN]

Not everyone on TPN has multiple lumens or multiple types of access. I've had patients with single lumen PICCs or single lumen ports who were on TPN at night only. During the day, that same line WAS used for blood draws, other IV meds, chemo, whatever we needed for. If we had to give meds that were incompatible with TPN while the TPN was running, the TPN was turned off briefly and the same line was used for the meds.

In a pediatric oncology patient with no veins and only one access line, you kind of have to make due with what you have.