TPN question

IVRUS, BSN, RN · Nov 3, 2011

I always got the idea that TPN could only run with lipids and nothing else - maybe I'm wrong. Is it possible to run normal saline into the same lumen as the TPN? What about when you have TPN and lipids? Can the NS go in the same line with both of those things?

You are correct... NS should not be piggybacked into TPN tubing. Nor should anything except for Lipids.

Double-Helix, BSN, RN · Nov 3, 2011

The policy in most places to run TPN/lipids through a dedicated line. TPN is mixed based on the patient's specific metabolic needs, so I would question the purpose for running additional fluid. The patient should be getting enough TPN that they do not need maintainance fluids. Many medications cause precipitation of the TPN and can't be run at the same time. It's common to run a fluid like NS or D5- sometimes with heparin- when the TPN is off to maintain patancy of the line.

But to answer your question, if a solution is compatible with TPN, it can be run together, but most facilities have policies regarding TPN administration. So I would check your facility's policy regarding this issue.

IVRUS, BSN, RN · Nov 3, 2011

But to answer your question, if a solution is compatible with TPN, it can be run together, but most facilities have policies regarding TPN administration. So I would check your facility's policy regarding this issue.

NO... Just because a solution is compatible with the TPN solution, does not mean it CAN go together. Not only are you concerned with compatibility of TPN with other solutions, but there is a real infection control issue. TPN is such a rich bag of nutrients, that anything piggybacked into a side port can introduce bacteria. This is the STANDARD of CARE, and should not be deviated from.

birdie22 · Nov 3, 2011

Thanks for your responses. There was a situation a couple weeks ago where a patient was getting TPN/lipids and also was getting NS as maintenance fluid. I had the TPN going through the PICC and the IVF going through a peripheral.

A couple times I would get called into the patient's room bc the IV machine was beeping. It would say 'paused' and stuff like that. Well I never once pressed the 'pause' button. I think he was messing around with it and maybe injecting stuff into his peripheral line (known history of drug abuse). I would go in and there would be blood in the tubing. This is all a gut feeling I have, no actual evidence. I would say stuff like 'that's odd that there is blood in the tubing. I wonder why the machine says paused'. His response....'um, yeah, it just started beeping. I dunno what happened'.

And now I'm sitting at home weeks later wondering to myself what ever happened with that situation and if I could have combined the lines and d/c'ed the peripheral.

turnforthenurse, MSN, NP · Nov 3, 2011

TPN needs to be on it's own dedicated line. You can hang lipids with the TPN, but the lipids needs to be on it's own separate IV pump and then connected to the Y-port BELOW the filter.

Double-Helix, BSN, RN · Nov 3, 2011

NO... Just because a solution is compatible with the TPN solution, does not mean it CAN go together. Not only are you concerned with compatibility of TPN with other solutions, but there is a real infection control issue. TPN is such a rich bag of nutrients, that anything piggybacked into a side port can introduce bacteria. This is the STANDARD of CARE, and should not be deviated from.

I said it CAN be run together, not that it SHOULD. The first sentance of my post says that TPN should be run in a dedicated line.

IVRUS, BSN, RN · Nov 3, 2011

I said it CAN be run together, not that it SHOULD. The first sentance of my post says that TPN should be run in a dedicated line.

But saying it can, when it really can't may be a matter of semantics. Therefore, I wouldn't say it could run together if it can't. LOL...

I just think it's important not to disseminate the information that it's "okay" to run together as long as it's compatible in the case of TPN.

nurseprnRN, BSN, RN · Nov 3, 2011

"and now i'm sitting at home weeks later wondering to myself what ever happened with that situation and if i could have combined the lines and d/c'ed the peripheral."

yeah, you could, and the infection control issue would be moot because he'd be injecting into it anyway. :uhoh3:

seriously, nothing gets run into the same line (or drawn from it either, come to that) as tpn/lipids. it's not a compatibility issue, it's an infection-control issue.

tryingtohaveitall · Nov 3, 2011

Hmm, do you all never have issues of not having enough lines? Unfortunately, we often have issues where we have more meds, blood products, pressors, etc to be given than we have lines. We have always in the 21 years that I've been in our PICU run compatible fluids and meds with Hal and IL. Our infection rate is extremely good, at one point we went years without a CVL infection. This is per hospital policy and approved by pharmacy and our Nutritional Support Team (IV therapy).

birdie22 · Nov 3, 2011

Why they waste their time putting in only a single lumen PICC drives me crazy sometimes. If you're going to place a central line, might as well have more than one lumen.

tryingtohaveitall · Nov 3, 2011

Why they waste their time putting in only a single lumen PICC drives me crazy sometimes. If you're going to place a central line, might as well have more than one lumen.

ITA, however, sometimes these are kids with double and triple lumens and it's still not enough. One recent example was on 3% NS, receiving blood products, vasopressors, antibiotics, Hal, IL, pentobarb....