At my last job in the NICU, we changed our TPN tubing Q72 hours, this seemed to help our infection rate. At my new job we change it Q24 hours. We have a problem with infections in the new unit. Of course the TPN itself is changed Q24, I'm just talking about the tubing. I'm wondering if breaking into the line Q24 is not a good idea.
If you have any literature supportng Q72, could you please let me know?
I'm trying to give my manager some clinical evidence.
Maybe some of the confusion as to what the CDC guidelines mean has to do with how the lipids (change Q 24 hours) are infused.
In any NICU I have ever worked in, the TPN and Lipids are separate bags and tubing. Therefore, per the CDC guidlines, the TPN tubing is changed Q 72 hours and the Lipid tubing is changed Q 24 hours. (Bags for both are changed Q 24 hours.)
In other settings, I have seen the 3-in-1 solution in which the Lipids are mixed in the same bag as the TPN. In this situation, since there are Lipids in the tubing, the recomendation is to change the tubing Q 24 hours.
Actually, no it says any lipid containing solutions should have the administration set changed q24hrs.
Yes, I read that it says any lipids chould be changed Q24. Our lipids are hung separately from the TPN. It sounds like some hospitals mix the TPN and lipids together? Our TPN does not contain lipids. So, we would change the lipids Q24 and TPN Q72 according to the CDC.
Ummm...I think she answered the question correctly. They change bag + tubing q 24.
Q24 is also done at our facility, per CDC recommendations.
If you read the CDC website, thay recommend changing TPN no more frequently than Q72, lipids are Q24. So, the hospitals that change TPN Q24 are wrong because you are breaking into the PICC lines too often...which I think causes higher rates of infection. I'm going with what the CDC says, and it's not Q24! I guess, unless your TPN has lipids mixed in with them?!
Maybe some of the confusion as to what the CDC guidelines mean has to do with how the lipids (change Q 24 hours) are infused.
In any NICU I have ever worked in, the TPN and Lipids are separate bags and tubing. Therefore, per the CDC guidlines, the TPN tubing is changed Q 72 hours and the Lipid tubing is changed Q 24 hours. (Bags for both are changed Q 24 hours.)
In other settings, I have seen the 3-in-1 solution in which the Lipids are mixed in the same bag as the TPN. In this situation, since there are Lipids in the tubing, the recomendation is to change the tubing Q 24 hours.
nell
Thank you, that's what I was wondering. I think most places hang the TPN and lipids separately...does anyone here hang TPN that has lipids mixed in with it??
Right, they are hung separately, but they are usually piggybacked in or y'd in, so all the tubing has to be changed every 24 hours. We change out TPN everyday regardless due that many of our kids are on D12 or higher and that is a great medium for fungus and bacteria.
We just rewrote our policy to state this about the IL being piggybacked into the line, so it has to be changed from top to bottom every day.
Other fluids are only good for 24 hours (premixed ones) but the tubing stays for 72.
We change TPN q 72 and lipids q24. Depending on the babies IV, PIV,PICC, the last piece of tubing is a Y-connector that is changed every 3 days. The TPN goes in one side and the lipids infuse through the other. We use double lumen UVC's, double spike the TPN, and run the lipids in through the stopcock on one side. This way we do not have to change all the tubing every night.
I've seen numerous times where a kid's triglyceride level goes too high and we will turn off the lipids for several hours and test again before turning them on...how do you handle that if the IL is mixed in the TPN?
I guess, unless your TPN has lipids mixed in with them?!
nell
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Maybe some of the confusion as to what the CDC guidelines mean has to do with how the lipids (change Q 24 hours) are infused.
In any NICU I have ever worked in, the TPN and Lipids are separate bags and tubing. Therefore, per the CDC guidlines, the TPN tubing is changed Q 72 hours and the Lipid tubing is changed Q 24 hours. (Bags for both are changed Q 24 hours.)
In other settings, I have seen the 3-in-1 solution in which the Lipids are mixed in the same bag as the TPN. In this situation, since there are Lipids in the tubing, the recomendation is to change the tubing Q 24 hours.
nell