Do you change your TPN tubing Q24 or Q72??

Specialties NICU

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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 course the TPN itself is changed Q24, I'm just talking about the tubing. I'm wondering if breaking into the line Q24 is not a good idea.

If you have any literature supportng Q72, could you please let me know?

I'm trying to give my manager some clinical evidence.

Thanks

Specializes in NICU, PICU, educator.

We don't mix lipids with TPN...too many meds that aren't compatible per our pharmacy.

This is a hot spot in our unit right now. We change out everything every 24 hours right now because we piggyback our IL at the port below the filter, so the whole line is "contaminated". I think we are going into these lines way too much as it is.

Specializes in NICU.

Just wondering how many of you change the lines under sterile technique?

Specializes in NICU, PICU, educator.

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.

We change TPN and Lipids q24h as suggested by CDC. Our UAC lines get changed every 72 hours.

Specializes in NICU.
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.

Yep, 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.

Specializes in Palliative Care, NICU/NNP.

I 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). "

Specializes in NICU.
I just looked at the CDC site and my question is, do you infuse lipids separately?

We 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.

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.

Every 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!

We change the TPN tubing Q72 and the bag Q24

Specializes in NICU.

For 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.

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