IV scenario

jnette, ASN, EMT-I · Mar 25, 2006

I'd call the Pharmacy for input about whether we could run the TPN/lipids together, as mentioned by Triage. I would not stop the TPN, nor would I use the TPN line for anything else.
If Pharmacy wasn't available, I wouldn't guess.
I might run the blood over a couple of hours, then run the antibiotics afterward through the same lumen.
I like the peripheral line idea also, but I'd probably transfer the blood line to the peripheral and run the antibiotics in the central line.
So let us know what the answer is, please, because now I'm really interested in finding out.
And Danigirl, I don't know about how it works in Canada, but I don't think we're allowed to give those antibiotics by IV push. Especially Vanco, because if Vanco runs too fast, the patient can have a reaction called "Redman Syndrome." So Gent and Vanco are infused.

Agree with the above. Gent can be given IVP, but not vanc.

Still having trouble with running TPN and lipids together, though. No med/surge expert here.. far from it, actually. But I always thought this was a major no-no?

I wouldn't see a problem with temporarily stopping the TPN/Lipids to run the abx. But I would not run anything else through those lines as mentioned above. I'd start a peripheral line for the abx.

I may be waaaay off, too, and like the others, would certainly like to see the proper way of doing this! :uhoh3:

nursepearl · Mar 25, 2006

I work on a bone marrow transplant floor. We have many pts on chemo, tpn, pca's. getting multiple abx and many, many blood products. So, we run into this kinda thing frquently.

We run TPN and lipids together...I have never seen them run seperate. I would have one line free for abx at all times....and since it is a triple lumen in this case, I would have one free for blood products and one free for abx. We also do somtimes run abx with tpn if the pharmacy okays it. Also, to keep lines free we almost always have the pca's long lined into the tpn (which are also compatable....morphine and dilaudid with tpn that is).

I have never stopped TPN without tappering first....very unsafe unless they have been on TPN for years.

traumamomtx · Mar 25, 2006

I know that our institution we never stop TPN and if we run out before a new bag arrives we hang D10. Also, our TPN comes to the floor tubing and all so there isn't even any place to hang lipids with it if I wanted too. I would continue to run the TPN, hang the blood (because the pt is obviously getting it for an important reason), run the lipids either in the 3rd port or get a peripheral started, then when one of those ports either blood or lipids is finished hang the gent and then vanc. since vanc takes 1 hr to run. I'm eager to hear the answer too.

jnette, ASN, EMT-I · Mar 25, 2006

I work on a bone marrow transplant floor. We have many pts on chemo, tpn, pca's. getting multiple abx and many, many blood products. So, we run into this kinda thing frquently.
We run TPN and lipids together...I have never seen them run seperate. I would have one line free for abx at all times....and since it is a triple lumen in this case, I would have one free for blood products and one free for abx. We also do somtimes run abx with tpn if the pharmacy okays it. Also, to keep lines free we almost always have the pca's long lined into the tpn (which are also compatable....morphine and dilaudid with tpn that is).
I have never stopped TPN without tappering first....very unsafe unless they have been on TPN for years.

True enough... tapering is definatelty a must.. I do remember that now. As well as IF you HAVE to stop it for any reason, to hang D10.. the blood glucose issue, of course.. see how quickly I had forgotten that?

Told ya I was no expert at this stuff. And thanx for the okays on running TPN and Lipids together.. for some reason I always thought they were to be separate. :rolleyes:

HyperRNRachel · Mar 25, 2006

Why bother...the antibiotics will only be run over half hour probably. There should be plenty of residual left in stomach to cover that short time. I say just stop TPN, for the half hour then resume after antibiotics have run. If not sure how much is in stomach just do a quick check for residual.

Vanc in 30 minutes?????? If so, there are two antibiotics to run back to back that will take an hour at the very least and that is too long to stop the TPN. I'm with finishing the blood then starting the antibiotics or running the TPN with lipids in one line in order to free up a line for antibiotics.

Zee_RN, BSN, RN · Mar 25, 2006

I have *always* run TPN & lipids together. I've never seen it done any other way, in 11 years of nursing. They're even mixed in the same bag, although my hospital just started doing that (my previous hospital always did it, at least for the 10 years). Call the pharmacy; see why the TPN and lipids AREN'T running together; is it a company policy?

nurse_ange1 · Mar 26, 2006

I work on a Surgical floor, and we always have at least 2-5 pts with tpn going... :specs:

1) Blood in distal lumen, if they need the blood they are obviously quite sick right now

2) TPN with lipids connected below the filter (I've never seen it connected on its own port)

3) One empty port which allows for IV ABX... Gent first over 30 minutes and then I'd keep a TKVO of NS of 30cc for 10-15 minutes to fully flush line and then I would run the Vanco for an hour and then then the TKVO run for 10-15 minutes before putting it on standby (this all assuming I have a 3 line IV pump which isn't always the case if they've just come onto the floor). Our pharmacy prepares the meds in bags, standard dose of Gent in 100cc and Vanco in 250cc. Our TPN is devilvered everyday at 3pm... if we run out we are to run D5W (recenlty changed from D10) at the rate the tpn was at to prevent hypoglycemic shock.

Thats just what I'd do... be interesting to see what your prof says.

:typing

:nurse:

NYNewGrad · Mar 26, 2006

I'm with Nurse Angel. We run into these situations on my medsurg floor all the time.

The blood line never gets interrupted - too sensitive and has a time limit to infuse. Our TPN and lipids are also ALWAYS hung together, with the lipids connected below the filter. Third line is for whatever needs. In this case, run the gent over 30, flush the line with NS, and then run the vanco over an hour on a pump. It would be nice to attempt to get a peripheral 20G or even 22G if needed and then you can run antibiotics through there.

If you're really stuck, and the antibiotics are schedule BID or such, wait the hour or two for the blood to finish infusing and then run the antibiotics. This would only be done if you first OKed it with NM or doc.

There were times when I had 3 seperate infusion through each of the ports that really couldnt get touched. I called pharmacy and we tried seeing what could be IVPB into what, and if not told doc we needed another access.

Here's what I found on a website: (http://vumcpolicies.mc.vanderbilt.edu/E-Manual/Hpolicy.nsf/AllDocs/64CC2106BCB045ED86256923005148AC)

Avoid administration of medications via TPN line. In patient populations with limited venous access, compatible drugs may be infused with TPN only under the following conditions: a multi-line infusion pump or a closed system is used; drug is compatible with the TPN and with the lipids (when lipids are used); TPN is infused on the continuous mode.

EXCEPTION: In pediatrics, incompatible drugs may be given via the TPN line when: TPN is discontinued; line is flushed before and after the drug; patient is monitored for fluctuations in blood glucose when TPN is interrupted for greater than one hour.

With central TPN, lipids may be given on a continuous or intermittent basis.

VickyRN, MSN, DNP, RN · Mar 26, 2006

Nice resource on central lines and the different ports (distal, medial, proximal):

http://www.icufaqs.org/CentralLines.doc