Infusing TPN

Tweety, BSN, RN · Jul 21, 2003

Question. Does one have to wear a mask when hanging piggybacks on someone who doesn't have a running IV, but a central line? Seem like if when drawing blood you have to, then the same should apply with intermittant antibiodics.

That definately doesn't happen where I work.

nowplayingEDRN · Jul 21, 2003

Again, let me reinforce...each facility has a different SOP for doing things. Usually for changing caps, sterile technique is enough but when the dsg change is done, not only should the nurse be masked and gloved but the pt should also wear a mask and be instructed to turn their head away from the insertion site while the dsg change is being performed. I made the offer to Gwenith but I would be delighted to share with my other co-workers and colleuges here on the BB. I have developed an inservice on CVADs....if anyone would like to see it FYI....I have it is in 2 formats...Power Point and MS Word.

Tweety, usually if the suspect is a central line that has been left too long, we always drew 2 BCx from 2 seperate sites and the MD came in and removed the TLC and the tip sent to the lab for C&S.....and if necessary, insert a new cath in a different location. Believe it or not but some TLC manufacturers have recommended dwell times.

Tweety, BSN, RN · Jul 21, 2003

Originally posted by UntamedSpirit
Tweety, usually if the suspect is a central line that has been left too long, we always drew 2 BCx from 2 seperate sites and the MD came in and removed the TLC and the tip sent to the lab for C&S.....and if necessary, insert a new cath in a different location. Believe it or not but some TLC manufacturers have recommended dwell times.

Are one of those sites for the BC drawn from the central line? Nurses at our facility d/c central lines, and definately send the tip for culture if the patient is febrile.

nowplayingEDRN · Jul 21, 2003

No, Tweety.....that would be 2 different venipuncture sites. The site that will be used for the veinipuncture is cleansed with either betadine or chlorhexadine and then the blood sample is taken. If it is the RN d/cing the TLC then...she would send the tip for culturing.

Tweety, BSN, RN · Jul 21, 2003

Here, we do one peripheral site and one bc from the central line.

P_RN, ADN, RN · Jul 21, 2003

I guess this goes with beating a dead horse, but I still want to read the policy from the #1 cancer treatment center. Passing- thru where can it be found?

helix · Jul 21, 2003

Okay,

Having read everyone's posts, I would like to add my two cents, whether I am right or wrong. We hang TPN thru the central line that has lipids already in it. We are NEVER allowed to piggyback anything into it. I was surprised to read that other hospitals allow it.

Secondly, we draw blood from our central lines, and have a very low incidence of infection. For a while, we had a high rate of infection, but the infection control team found that it was the type of dressings we were using, and this was changed. We keep close records on infections and the events surrounding them. We have dead-ender valves that have a blue membrane that wipes clean and is needleless. We are by policy to change them with every blood draw, but I know for a fact that I am one of the only nurses to do this. We wear gloves and clean the membrane and hub with alcohol, draw out the blood, hand it to the lab person with the alcohol wipe between our gloved hand and the hub, then draw another, and flush the line. I prefer to clamp the tubing, use the alcohol to take off the old dead-ender and attach the new one that has a syringe with my flush solution on it, then unclamp and flush.

I would like to know from those that do ivpb into the tpn...do you use a separate pump or interrupt the tpn? I wonder about the drop in blood sugar as well.

Also, we have a policy that allows hyperal thru a peripheral iv dependent on the osmolality of the solution. We always protest, but there are a couple of doctors that do it anyway.

jnette, ASN, EMT-I · Jul 21, 2003

re the CVADs...

in hemodialysis a good one third to one half of our patients have central venous catheters.. permanent.. and most of our patients come to us with one in place until their fistula

"strengthens" or their graft surgery site is ready to use. Often it takes up to 6weeks for a fistuals to be ready to use.

On all these patients with either temp. or permanent catheters, we must draw labs weekly and some more often. Not only that, but these catheters are opened, heparin blocks removed,flushed, and attached to the bloodlines for dialysis 3x/wk., plus at the end of tx. once again detached, flushed and blocked.

With all the above opportunities for potential infection to set in by "careless nurses", I find it amazing that in the 6 years I have been doing this, we have had only 2 cases of sepsis.. and both due to the patients' personal hygiene habits... (ie., chewing tobacco at home, and dribbling saliva and tabacco onto their chest, which somehow even manages to get underneath the transparant dressings.)

All our labs (and there are MANY) are drawn through the CVAD before the start of tx. We use clean, not sterile gloves, nor do we prepare a sterile field. We DO wear a mask as does the pt., ANYtime we remove the caps and draw labs or attach/remove the lines. The catheter ends are wrapped in betadine soaked 4x4s for 10 minutes before removing the caps, and at the end of tx., before we detach the lines, flush, and block.

So I just don't think the "careless nurses" theory holds water, nor does the thought that accessing these lumens to draw blood or labs perpetuates infection/sepsis.

JMHO here...

:confused:

renerian, BSN, RN · Jul 21, 2003

Follow hospital policy. renerian

jnette, ASN, EMT-I · Jul 21, 2003

I agree, Ren. And this is our written policy.

ceecel.dee, MSN, RN · Jul 22, 2003

Originally posted by Dplear
TPN on the average costs 28 (twenty eight) dollars a bag to make. The most expensive item in the TPN is the bag itself which goes for around 20-25 bucks. The average charge is around 2000-3000 dollars a bag. Nice profit there.

Dave

:eek: WOW! I thought it was a lot more....I mean...way more!

I'm going to ask a friend in the office to show me what we charge!

ceecel.dee, MSN, RN · Jul 22, 2003

Originally posted by New CCU RN
That is absurd not to draw through a central line...... and sorry that your world class nurses have infected lines at your world class hospital, but at other places... that isn't the case.....

I must agree.