Do you disconnect lipids from TPN when complete

[sistrmoon, BSN, RN]

When you have 24 hour TPN running with a 10 hour bag of lipids, do you disconnect the lipid bag/line or not when it's completed? Why or why not?

[KelRN215, BSN, RN]

Yes. When I worked in the hospital, lipids, lipid tubing, etc could not hang for longer than 12 hours.

[sistrmoon, BSN, RN]

Faster rate of bacterial growth than the TPN?

[IVRUS, BSN, RN]

The bag of Lipids and its tubing should be removed and discarded. If I am understanding you correctly, the pt receives this once a day over a 10 hr period. Therefore, the tubing, nor the bag can be used any longer than 24 hours anyway, so pitch it if for nothing else but to avoid someone from using it. It is an infection control issue.

[sistrmoon, BSN, RN]

The lipids are connected into the tpn tubing so it would all be discarded at the 24 hour mark anyway. The lipids are not connected with a normal leur lock connection that is easily disconnected. It often takes clamps and then you have to use a cap creatively on the tpn tubing to close the system. I'll see if I can find a picture. I guess my point is if the lipids do not grow bacteria faster, why remove them as you're opening the line up and it doesn't seem designed to be removed anyway.

[KelRN215, BSN, RN]

The lipids are connected into the tpn tubing so it would all be discarded at the 24 hour mark anyway. The lipids are not connected with a normal leur lock connection that is easily disconnected. It often takes clamps and then you have to use a cap creatively on the tpn tubing to close the system. I'll see if I can find a picture. I guess my point is if the lipids do not grow bacteria faster, why remove them as you're opening the line up and it doesn't seem designed to be removed anyway.

Why would you connect lipids in such a way that they cannot easily be removed? Especially if the lipids are to hang for 14 hrs fewer than the PN? We did this one of 2 ways when I worked in the hospital. 1) attached the lipid tubing to the Y site on the PN tubing. Easily discarded when done. 2) Used a bifuse, a cap goes on each end of the bifuse so if you have to disconnect, the system is still closed.

[VANurse2010]

Yes. When I worked in the hospital, lipids, lipid tubing, etc could not hang for longer than 12 hours.

That's what I was always taught, but at my hospital they hang for 24 hours - both the lipids and the TPN.

[sistrmoon, BSN, RN]

From cdc's recommendations:

"Replace tubing used to administer blood, blood products, or fat emulsions (those combined with amino acids and glucose in a 3-in-1 admixture or infused separately) within 24 hours of initiating the infusion [182–185]. Category IB"

That's from 2011, maybe I'm missing a more recent doc that addresses it. Same doc says no rec can be made regarding how often to change port needles, which is interesting.