Made a mistake

[smartnurse1982]

Ok,so I was distracted at work by this patient who was moving around(peds) and he gets tpn.After the keppra infused I cleaned the port but forgot to flush with the 3 ml ns and started the tpn.. The keppra was 1000 mg in 100 ns.What can happen? The tpn infused for three miinutes before I thought of it. I then flushed it,but with the little tpn(its about 1.5 ml that infuses a minute). What could happen?

[IVRUS, BSN, RN]

First of all, this pt should have at least a double lumen, as TPN should have its own dedicated line. No other medications, or blood draws should be done in the lumen which gets the TPN. Secondly, If possible, I would have started a secondary IV just for the Keppra. But, if those aren't options, then flush well with the appropriate flush solution BEFORE you restart the TPN. The are a couple of main concerns namely incompatibilities and infection. By not clearing the line, a precipitate could have formed which could crystalize inside the catheter and occlude it, or send the precipitate into the patient's vascular system. And, each time you enter the system, you increase possibilities of introducing bacteria into that system. TPN is a rich medium, and bacteria love it. Hence, the desire for a dedicated lumen.

[cmimmel]

I completely agree with the other commenter. Any patient with TPN running should have more than one lumen or point of access if at all possible. TPN is sticky and heavy. It can coat the inner lumen of a catheter, epecially without proper flushing. This is breeding ground for bacteria and fuel for a possible precipitate which can possibly ruin an entire central line, necessitating replacement.

[iluvivt, BSN, RN]

Agree with IVRUS...when Lipids are added in the infection risk is even higher.It is the Lipids that can build up in the catheter more so than the hypertonic dextrose .We always advise the nurses that when they are changing the tubing they should flush with with a good volume of NS 10-20 ml pre fill.

Yes! should always be a dedicated CVC for TPN and at the very least a dedicated lumen.Many hospitals are using antisepetic or antimicrobial catheters on these patients as well.