What is wrong (if any)with this picture?

Nurses General Nursing

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You come on shift and have a pt with a triple central line. Looking at the IV bags, you see a routine IV bag hanging. Your eyes shift to the TPN and Lipids that are infusing. The Lipids are the primary IV solution. The TPN is piggybacked with the filter above the pump mechanism and then the two run in together to the patient.

Specializes in Med/Surg, Trauma and Psychiatry.
You come on shift and have a pt with a triple central line. Looking at the IV bags, you see a routine IV bag hanging. Your eyes shift to the TPN and Lipids that are infusing. The Lipids are the primary IV solution. The TPN is piggybacked with the filter above the pump mechanism and then the two run in together to the patient.

It is more than scary the things that some nurdes do. If that happened at the hospital I work at, the nurses would be written up and called into the Head Nurses's office plus they would have to do some kind of teaching activity on TPN/LIPID administration for the unit. My 'thing' is, if you are admitted to the hospital or you have family in the hospital you have to have someone there 24/7 to watch what is going on and to be your advocate, if not you can be messed up big time. As far as I know you never piggyback anything with a PCA except for plain IV fluids, and it is piggy backed to the lowest port. Also, as the OP said, lipid is piggy backed into TPN not vice-versa. I am of the strong opinion that many patients who die in hospitals did not die from the disease that brought them in or from natural causes ... they die from the negligence of ... (read my lips for the rest of the sentence). I am saying this from many years of working in acute care units.

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Specializes in Telemetry, ICU/CCU, Specials, CM/DM.
it is more than scary the things that some nurdes do. if that happened at the hospital i work at, the nurses would be written up and called into the head nurses's office plus they would have to do some kind of teaching activity on tpn/lipid administration for the unit. my 'thing' is, if you are admitted to the hospital or you have family in the hospital you have to have someone there 24/7 to watch what is going on and to be your advocate, if not you can be messed up big time. as far as i know you never piggyback anything with a pca except for plain iv fluids, and it is piggy backed to the lowest port. also, as the op said, lipid is piggy backed into tpn not vice-versa. i am of the strong opinion that many patients who die in hospitals did not die from the disease that brought them in or from natural causes ... they die from the negligence of ... (read my lips for the rest of the sentence). i am saying this from many years of working in acute care units.

we never, ever piggybacked anything into a pca. lipids should always be piggybacked into tpn and the only other thing was diprivan (only if it was a last resort). i still cannot believe that any nurse would think that this is ok. we would have also gotten hung up for this too!!!!!

christy,rn

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Specializes in Critical Care.
You come on shift and have a pt with a triple central line. Looking at the IV bags, you see a routine IV bag hanging. Your eyes shift to the TPN and Lipids that are infusing. The Lipids are the primary IV solution. The TPN is piggybacked with the filter above the pump mechanism and then the two run in together to the patient.

I started to think about this until my brain twisted. I am a visual person, so I may not be "reading" this post correctly. Where I currently work, lipids are added to TPN so we don't have to worry about this. However, in the past, when running TPN and lipids, the TPN was the primary solution and the tubing went through one pump. The lipids were secondary and went through another pump (because rates for both were usually different) and the lipids were piggybacked to the TPN port closest to patient and filter. I would probably **** my pants if I saw this, however, just seems kind of backward, however; the pump will go off if one infusion off or one bag not hung lower. ICU/SDU nurse who loves to see triple lumens, combine TPN and lipids if you can.

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Specializes in PICU, ICU, Transplant, Trauma, Surgical.

I currently work in PICU, and have worked in ICUs my entire nursing career. All of our TPN and IL run on an IV pump, never piggybacked as you described. So IMO everything is wrong with that picture! With all of the additives and electrolytes in TPN, I would think that hospitals would REQUIRE TPN to be ran through an IV pump.

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before even reading any of the responses on this, here is the bottom line as far as I am concerned: TPN and lipids, like blood, should always be administered separately. Lipids don't need a filter, TPN does. The tubing has to be changed every 24 hours.

Some things never change. If for no other reason not to run lipids and TPN together, one needs a filter, the other does not.

TP

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Specializes in Med/Surg/Tele/Onc.

At our place lipids, TPN, and insulin were in the same bag, mixed by pharmacy, changed every 24 hours. Always in a separate line/lumen.

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I guess if they are all in the same bag they could go into the same line, but I still wonder about the filter...

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before even reading any of the responses on this, here is the bottom line as far as I am concerned: TPN and lipids, like blood, should always be administered separately. Lipids don't need a filter, TPN does. The tubing has to be changed every 24 hours.

Some things never change. If for no other reason not to run lipids and TPN together, one needs a filter, the other does not.

TP

As others have stated, TPN and lipids are frequently all mixed together in ONE bag.

TPN and lipids can be run together, the TPN gets a filter, the lipids are connected to the port below the filter.

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thanks for the heads up. I did interventional cardiology for a long time; never really worked with this stuff until recently. I am learning so much by going back to med-surg!

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Specializes in Tele, Med/Surg, Case Mgmt, Ins. Rev.

I always ran the Lipids primary thru pump into central line port. The Lipids ran on a seperate pump, but was piggybacked into the Lipids at the final port that was proximal to the patient, but distal to the filter. I used silk tape and clearly labled the TPN line and the Lipid Line with med/date/time/initials to prevent someone from inadverdantly disconnecting or trying to push a drug, run an IVPB, etc. I would typically use the white port on the TL for this. I would also try and use a double pump and would also place a tape lable near the door lock listing the TPN and Lipids and would activate the lock out on the back of the pump to prevent someone from accidentaly changing the rate.

If I had IVF, PCA, etc. I would try and utilize the Blue port for these, and attempted to keep the red port patent for blood draws. It would always amaze me the IV tubing spaghetti I would find at the beginning of my shift, or the multiple piggybacks into a single IV line.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
I guess if they are all in the same bag they could go into the same line, but I still wonder about the filter...

Adding the lipids to the main bag to infuse in 24 hours makes the lipids dilute enough the filter isn't a problem.

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thanks for the heads up. I did interventional cardiology for a long time; never really worked with this stuff until recently. I am learning so much by going back to med-surg!

Exactly the reason instructors/other nurses recommend a year or two of med-surg after school :) It't almost a continuation of nursing school while stuff is still fresh :) Interventional cardiology must have been a lot to learn as well- the procedures they can do now is pretty amazing :D

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