I work in ltc and...

Anna Flaxis, BSN, RN · May 11, 2012

I'm not crazy about the idea. I think return demo/skills checkoffs are an important part of the process. How will you do that online?

RpeNa · May 11, 2012

I'm not sure how this will work either. I'm skeptical about doing it this way. I also made sure they knew I was not going to do it unless they get pumps. I will not do it to gravity...

RpeNa · May 11, 2012

Am I wrong telling them that?

RpeNa · May 11, 2012

I meant, am I wrong for telling them that?

mikeicurn, ASN, RN · May 11, 2012

Not to come across as a smart aleck, but didn't you learn central line care in school? We covered all this in school, and I didn't get any extra training when I started at the hospital. I understand needing a little refresher training if it's been a couple of years, but surely you must have covered the material before, so on online refresher should be adequate. I agree, I would want it run on a pump as well. Really most IV's should be on a pump when it's possible. If it's gravity feed, and it stops, it tends to clot off lines. If a pump stops, it alarms you immediately.

lovenursing21 · May 11, 2012

your pharmacy should come out and do a training before you get your first TPN patient.

amoLucia · May 11, 2012

Unless I'm wrong (but I don't think I am), TPN is ALWAYS, ALWAYS run on a pump R/T potential for unbelievable danger of a runaway infusion. For this reason, personally I would never do TPN without a pump. Also something to keep in mind about your med room --- you'll need a BIG refrigerator for those huge bags, and it needs to be CLEAN (that means, no staff clothing, rainy umbrellas, dirty boots, boxes of briefs and blue pads, pizza boxes, etc. Your technique and environment for TPN must be top notch for infection control. And make sure your place has plenty of IV poles. The poles used for enteral feedings are frequently less than pristine, so having a fleet of sturdy clean poles is a must. You'll also want to have sufficient glucometer equip. And since your LTC facility is new to TPN, a CEU-type course on its management would be a good idea. Also, there are courses on PICC line mgt (the do's and don'ts kind of stuff --- I don't think you were talking about insertion as that's not online.

Anna Flaxis, BSN, RN · May 11, 2012

No, you're not wrong. TPN needs to be on a pump.

I imagine the patients will have their PICC lines inserted while in the hospital, and you will be responsible for line maintenance after discharge. The keys for maintaining a PICC are infection control and maintaining patency.

For infection control, you'll need protocols for proper hub scrubbing, cap and dressing changes, tubing changes, and medication storage. For maintaining patency, flushing protocols and de-clotting protocols need to be in place.

"You learned central line care in school" is not good enough. Your facility needs to have policies, procedures, and protocols in place. This is both for the protection of the patients and the nursing staff.

You are not wrong to tell them "No" if they want to push this on you without proper training and education, and implementation of P&P.

amoLucia · May 11, 2012

Thank you, Stargazer, for the additional reminders. It's been a while since I've done TPN as not all facilities in my area do it. Some very practical info here. One last thing ... the facility will need a strong contract with its laboratory services providers R/T all the frequent lab values needed.

RpeNa · May 11, 2012

Thank you so much for your replys... You have given me alot of good information to ask about!..

mikeicurn, ASN, RN · May 12, 2012

"You learned central line care in school" is not good enough. Your facility needs to have policies, procedures, and protocols in place. This is both for the protection of the patients and the nursing staff."

Right, and my hospital has all those. We get them in our communication book and in CBI's. My point was don't you think getting these policies online would be sufficient? Do you really need demos and skill check offs?