oops?

[mediatix8]

I work the night shift and am a new graduate.. I had a patient who earlier that day was put on TPN through his mediport. During the night I had to hang a bag of dilatin and was confused about how to do it... he didn't have any PIVs, just the mediport. I thought maybe I could call the oncall pharmacy and see if his TPN was compatible, which I didn't think it would be. I knew I could try to start a new IV, but he was a hard stick. I figured that a good idea would be to turn off the TPN and flush his line with a lot of saline before and after the bag of dilatin. I consulted with the charge nurse to see if it was OK to just flush it with maybe 20ccs before and after. She told me I could just attatch a y site to the mediport and infuse them together. I didn't think that sounded right, because then they would be mixing together still in the tubing. There's about 6 inches of tubing where they would be mixed together. She said that that little bit is OK, if they were mixing together throughout the whole tubing it would be different. Well, she has 30 years of expereine as a nurse and I have one month of experience on my own, so I did it. The IV pump started saying "occlusion" and wouldn't continue. I checked the lines many times to see there was no occlusion. I flushed the mediport and everything and it flushed fine, but it still said occlusion and wouldn't go. I had the charge nurse look at it and she said I set it up as she told me to and to just try reaccessing it again. She had tried flushing it and that time it wouldn't flush. So I accessed it again and set it up as before, asking her again if she was sure it was OK to do that, and the same thing happened with "occlusion." I tried accessing it again and just ran the dilntin seperately, then resumed the TPN. Later I found that his mediport was infiltrated. He is now going to have a PICC line. Was the charge nurse wrong?

[limabean]

I have always heard to never hook anything up with TPN also. However, the other day I had a patient who had a triple lumen with TPN in one line then I had to start Amiodarone and Cardizem thru the other two. The docs then wrote for a Magnesium infusion over 3 hrs. I called pharmacy to see if I could run it with anything and the pharmacist said I could run it with the TPN in this situation b/c mag was already in the solution. I did that and everything went fine. Can anyone tell me if this is wrong? Just curious.

[hrtprncss]

I have always heard to never hook anything up with TPN also. However, the other day I had a patient who had a triple lumen with TPN in one line then I had to start Amiodarone and Cardizem thru the other two. The docs then wrote for a Magnesium infusion over 3 hrs. I called pharmacy to see if I could run it with anything and the pharmacist said I could run it with the TPN in this situation b/c mag was already in the solution. I did that and everything went fine. Can anyone tell me if this is wrong? Just curious.

that's fine..."Ridering" the mg on tpn is ok...Sometimes insulin gtt's are ridered with tpn also if you have multiple drips.

[Super_RN, BSN, RN]

Here's a word to the wise: if ever you have a question about compatibility, check a current IV drug book (every facility should have one handy) and/or consult your on-site pharmacist. This is the best way to prevent incidents like this one from happening.......don't rely on the word of another nurse, or even an MD---you need to take the time to check it yourself. Even experienced nurses have to do this from time to time, as it's impossible to keep up with all the changes in pharmacology and we don't usually have instant access to information about them.

As for TPN, it's safe to assume that nothing (other than lipids) can be infused with it, and even then you connect the line containing the lipids below the filter to avoid clogging it up. It sounds to me like this patient's doctor should consider a different central vascular access device, particularly if peripheral IV access is difficult and he's in the hospital frequently, but that's just my humble opinion.

At any rate, you've learned a valuable lesson here, and you'll never make the same kind of mistake again, so be gentle with yourself.:) Good luck to you!

Our IV drug book is a life saver! Actually, more like our "Bible"!

:) Jaime

[TypicalFish]

Here's a word to the wise: if ever you have a question about compatibility, check a current IV drug book (every facility should have one handy) and/or consult your on-site pharmacist. This is the best way to prevent incidents like this one from happening.......don't rely on the word of another nurse, or even an MD---you need to take the time to check it yourself. Even experienced nurses have to do this from time to time, as it's impossible to keep up with all the changes in pharmacology and we don't usually have instant access to information about them.

As for TPN, it's safe to assume that nothing (other than lipids) can be infused with it, and even then you connect the line containing the lipids below the filter to avoid clogging it up. It sounds to me like this patient's doctor should consider a different central vascular access device, particularly if peripheral IV access is difficult and he's in the hospital frequently, but that's just my humble opinion.

At any rate, you've learned a valuable lesson here, and you'll never make the same kind of mistake again, so be gentle with yourself.:) Good luck to you!

I couldn't agree more. It's my license, my job, my life. The OP had the right thought-call the pharmacy, or check it out in a drug book; or even -our hopsital has it online-look up whatever you hospital P&P's are on the issue. OR finally, If in doubt, DON'T!

[holikow]

:uhoh21: The RN who administers any IV med, is that patient's last line of defence! Remember the motto, "If in doubt, check it out." The court's will slam you hard if you harm any patient, even if the Nurse Manager told you it was "ok". YOU GAVE THE MED, NOT THE MANAGER.