Infusing TPN

AHarri66, BSN, RN · Jul 20, 2003

The ONLY thing we infuse with TPN is lipids, and that is attached below the filter.

passing thru · Jul 20, 2003

Are you in a major teaching hospital Tory?

Or a major cancer center?

Are these triple lumen central catheter intravenous lines?

In major cancer hospitals I worked in, and in some teaching hospitals, it was the same as you say.

Patients simply have so many intravenous medications....everything goes thru the TPN.

I have not seen any adverse or negative consequences .

WhiteCaps · Jul 20, 2003

I agree, NOTHING but lipids are to piggyback into TPN. There is too much risk of contamination/sepsis. We recently had a pt with only one central line site who was on TPN/Lipids. With the doc's written instruction, we did piggyback into the line because there was no other available access. That pt got septic, despite the most careful sterile techniques.

passing thru · Jul 20, 2003

Maybe the patient got septic from another cause.

Only if the catheter was removed that day and cultured by lab with blood and urine cultures, can you say with even minimum certainty

that

the

i.v.

was the source of the infection.

you can have a wound infection, an infected tooth, a UTI, and become septic

AND contaminate the iv catheter with bacteremia from those sites.

passing thru · Jul 20, 2003

tHE # 1 RANKED cancer center in the U.S. has been doing this for 25 years.

Their pts. have low white blood counts D/T immunosuppression.

I don't think they would put their patients at risk if infection were that easy.

One thing they DO NOT DO IS,.....DRAW BLOOD FROM A CENTRAL LINE.

TPN & lipids, antibiotics, iv therapy, yes , all go thru tpn line.

rileygrl11, BSN, RN · Jul 20, 2003

Thanks for the QUICK replies! And to "Passing Thru",...yes, I work at a major teaching hospital and it is the largest in our county. We have TPN most often through a PICC or it's peripheral parentral nutrition through an IV.

gwenith, BSN, RN · Jul 20, 2003

TPN is very acidic and some solutions are alkaline so there is a PH incompatablity. You can get dual lumen PICC lines and certainly triple and quad central lines.

Apart from the sepsis angle there is actually little researched and verifyable information about drug interactions within IV lines. Yes! there are texts that list what does and does not mix but not every drug is tested on every possible admixture.

Just because you do not "see" an interaction taking place does not mean that one has not occured.

WhiteCaps · Jul 20, 2003

I'm puzzled why Passing Thru says not to draw blood thru a central line? That's the first time I've ever heard that one. Why not?

When pt's have no available peripheral sites, that is the only way to get the labs! What do you do?

nursesearl, BSN, RN · Jul 20, 2003

I agree, WhiteCaps. In home care, we draw blood from a central line all the time.

gwenith, BSN, RN · Jul 20, 2003

Some place do not take blood through a central line but not because of sepsis more because it increases the risk of clotting the line. I have seen that with a PICC line took ages to get it in and the resident on the ward took blood but didn't flush the line (snorkle snarrk!!!! grrrr)

We do not take blood cultures from any existing line but will take bloods form a central line.

Tweety, BSN, RN · Jul 20, 2003

Originally posted by WhiteCaps
I'm puzzled why Passing Thru says not to draw blood thru a central line? That's the first time I've ever heard that one. Why not?
When pt's have no available peripheral sites, that is the only way to get the labs! What do you do?

Could be the risk of infection is high so why when drawing blood, in that you open a line for infection, their policy is not to do it.

We had so many TPN labs come out of whack on one of the surgical floors that the manager made it policy that labs couldn't be drawn from a central line when a person is getting TPN or Heparin.

On our floor if there is a line, we draw from it. Stop the infusion, waste 10 cc's, then draw your blood.