Infusing TPN

[rileygrl11]

I remember all through school having it drilled into my head that TPN was to infuse by itself and never to piggyback ANYTHING else into it. Where I work RN's consistently piggyback numerous drugs into the TPN line. Most often it is antibiotics, pepcid, morphine and zofran/phenergan. I am currently searching for info on this from the internet, but in the mean time would like your input. Thanks!

[RedWeasel, RN]

As it has already been pointed out, many meds can be piggybacked throught the same line as Hyperal but it is the Lipids which are incompatible with other medications. If you only have one one lumen on your central (or peripheral) line for whatever reason, you simply need to shut off the lipids, flush the line real well, and you can run most anything with the Hyperal. If you are using a pre-mixed bag of Hyperal/Lipids together, obviously that cannot be done. If you have more than one lumen, it is preferable to simply run your other meds through the other lumen.

Edited to add: The Hyperal should not be interrupted due to the risk of hypoglycemia so you should take care as to how you secondary meds are run with it.

That's pretty sad. The overwhelming majority of nurses I work with are simply too professional to be so sloppy and careless.Yes, there will always be an exception because we are human. It sounds like these people dropped the ball. They needed to re-educate their nursing staff instead of simply making allowances for gross incompetence leading to discomfort for the patient.

yeah! true I have never seen a nurse replace an old cap, or not wear a mask-or have the pt wear a mask. Use sterile gloves....I suppose it could happen but when you even go to change the dressings everything is in a kit at our place. If everything is provided for, how can you be sloppy, right? We know how easy it is to get, say, a PICC clotted off...pts with SDHs or cranis who aren't on anticoagulants are famous for it on our floor. Our orders say to flush at least q 24 hours. We know if it isn't flushed every shift it will most certainly clot off and then it is alteplase city! Which takes a long time to work. I think it goes back to orientation of nurses to a facility and continuing education, and just communication between coworkers-don't be afraid to ask each other questions....when in doubt don't chicken out--better to look a little uncertain now (ask does the pt have to wear a mask too?--even if you asked the same question last month) than to look really dumb later when you have been caught changing a dressing while the pt is coughing maskless onto the site, who later on comes down with a nice 104.0 temp....and when the PICC is pulled there is yellow stuff on the end...and when pp ask you 'dumb' questions don't treat them dumb-I just see more and more lately they forget how many questions they asked when they first started (I should take notes)...going to bed I ramble...

[Imafloat, BSN, RN]

We have a compatibility chart for patients on HAL/IL I was surprised to learn that Ampicillin isn't compatible with HAL, it can form crystals. We have always given Amp with HAL. We don't directly piggyback into the HAL line, we have a trifuse with a safety care for meds, HAL, and IL.