Do you change your TPN tubing Q24 or Q72?? - page 3
At my last job in the NICU, we changed our TPN tubing Q72 hours, this seemed to help our infection rate. At my new job we change it Q24 hours. We have a problem with infections in the new unit. Of... Read More
Dec 14, '06Occupation: Nurse of course! Specialty: NICU, PICU, educator ; From: US ; Joined: Feb '04; Posts: 1,838; Likes: 1,118We are changing over to totally aseptic techinque now...all central lines have to be changed with sterile attire. We weren't doing it and our sepsis rate has been high. We will use the two person method at first to see how it goes.
Dec 14, '06Occupation: RNC in NICU Joined: Aug '98; Posts: 49; Likes: 3We change TPN and Lipids q24h as suggested by CDC. Our UAC lines get changed every 72 hours.
Dec 14, '06Joined: Oct '04; Posts: 5,969; Likes: 1,404Quote from BittyBabyGrowerYep, that's what we're doing. All deep lines have to be changed under sterile technique, and we do the two person method. We've been doing it for months now and there's been a drop in our infection rates.We are changing over to totally aseptic techinque now...all central lines have to be changed with sterile attire. We weren't doing it and our sepsis rate has been high. We will use the two person method at first to see how it goes.
Dec 14, '06Occupation: gratefully retired Specialty: Palliative Care, NICU/NNP ; Joined: Jan '06; Posts: 470; Likes: 63I just looked at the CDC site and my question is, do you infuse lipids separately?
"Replace tubing used to administer blood, blood
products, or lipid emulsions (those combined
with amino acids and glucose in a 3-in-1
admixture or infused separately) within 24 hours
of initiating the infusion (158,226-229).
Category IB. If the solution contains only dextrose
and amino acids, the administration set
does not need to be replaced more frequently
than every 72 hours (226). "
Dec 15, '06Specialty: NICU ; Joined: Nov '03; Posts: 3,768; Likes: 252Quote from ginger58We infuse them through separate tubing but they combine with the hyperal at the Y-site. This way, the baby can get the exact amount of lipids needed over 24 hours since it's running on it's own pump. If we need to increase, decrease, or change the hyperal solution, we can do so without disturbing the lipids.I just looked at the CDC site and my question is, do you infuse lipids separately?
The only time I've seen them mixed together was with our babies who go home with Broviacs and TPN - the lipids and hyperal get mixed at the last second into the same bag and it runs for 24 hours. This is okay, though, because with these kids not only is the tubing changed Q24H, but they also don't have changes in their hyperal formulas like they would if they were inpatients having labs a few times a day.
Dec 17, '06Joined: Nov '04; Posts: 64Every time I've been taught how to hang new TPN, I have been taught to remove the excess TPN from the previous day's fluid due to the fact that the tubing contains quite a few hours worth of fluid due to the small fluid requirements of infants. So, essentially the policy is to change tubing every 72 hours, but you're still breaking into the line. And to think that I was oriented under the impression that the 72 hours were a money saving choice by the hospital administration!
Dec 20, '06From: US ; Joined: Apr '05; Posts: 91; Likes: 5We change the TPN tubing Q72 and the bag Q24
Jan 12, '07Occupation: playing science Specialty: NICU ; Joined: Feb '05; Posts: 3,131; Likes: 1,042For PIV, we change the TPN tubing q72 if running over 10cc/hr, q24 if the rate is slower than that. IL changed q24, because it's never running above 10cc/hr.
For PCVL, q24 regardless, done under sterile conditions.
UAC is q24, because we run our fluids at 1.2cc/hr.
UVC is not currently considered a central line like a PCVL as per our policy, but some of us change them sterilely anyhow.