PICC Lines And TPN

[pearldiaz]

Last hospital I was at, had nurses NOT touching picc's for any reason. IV team did all the work connecting and disconnecting anything relating to the PICC including TPN. At current hospital, I was told I could interrupt the TPN running in the single lumen to flush lasix IV, protonix, etc down and reconnect the TPN as long as it was a short interruption. What is the stanDard here? Confused..........

[NicuGal, MSN, RN]

We use only single lumen PICCs...we use a trifurcated filter on our lines...one is for TPN, one for IL and the third is for a med line, which is a closed system. We turn off TPN, etc as needed to give meds, we never disconnect for any reason except to change lines.

Our med line that goes to the trifurcated is comprised of a separate tubing which is has a flush at the end, we only disconnect at the flush syringe after cleaning the port vigorously and letting dry before hooking up the med, then repeat for the flush. We don't disconnect near the patient. We have only had 2 line infections in almost 18 months since starting this method. There are a lot of central line bundles that follow EBP and they work.

[blondy2061h, MSN, RN]

We don't have single lumen piccs, so the only time I have a single lumen to work with it mediports. If that patient requires TPN, I'll try twice for a PIV, have another nurse try twice, and then get an order to interrupt the TPN PRN. Unfortunately, I've had to interrupt even for things like blood transfusions. For an IV push drug I wouldn't think twice about pausing the TPN. I've never heard of only letting the IV team touch PICCs.

[blondy2061h, MSN, RN]

Our hospital only uses single lumen piccs except for in ICU. I have only dealt with 1 TPN patient but it is the norm for us to interrupt TPN for other meds. If the med isn't compatible, then we have to pause TPN, flush, run med through, flush, and reconnect TPN. We avoid it when we can, but sometimes this patient needs antibiotics or prn meds and is NPO so we have no other choice. We always call the pharmacist when we get a new med order, especially antibiotics to see if we can adjust the med schedule so that we are interrupting the TPN the least we can.

Our TPN almost always runs continuously. Just for my own curiosity, it sounds like you do your's intermittently?

[blondy2061h, MSN, RN]

Its a rare day that I have a triple lumen CVL that I'm not using all the ports of!

We recently switched to 5 lumen CVLs. Love it! I can get my meds in on 4 lumens, without being pressed, and save one for blood draws. It's wonderful.

[tokmom, BSN, RN]

I honestly don't get single lumen piccs. If the pt has to endure that procedure and cost, why not put in one with more than one lumen? I would love to have 5, how cool would that be? lol.

[blondy2061h, MSN, RN]

I honestly don't get single lumen piccs. If the pt has to endure that procedure and cost, why not put in one with more than one lumen? I would love to have 5, how cool would that be? lol.

Our standard for PICCs is two lumens. I once saw a patient from another facility with a 3 lumen PICC. It only worked okay- each of the lumens was too small to accomodate the three. The doubles work well. The 5 lumen CVLs work decently if they're placed well and flushed frequently. The smaller lumens aren't great for drawing blood, but the wider ones usually work well.

[AgentBeast, BSN, RN]

I honestly don't get single lumen piccs. If the pt has to endure that procedure and cost, why not put in one with more than one lumen? I would love to have 5, how cool would that be? lol.

The number of lumens directly correlates to infection rates. More lumens = increased risk of infection.

[K+MgSO4, BSN]

TPN has a high level of dextrose anywhere between 11-25%. The problem with this is that it is a great media for bacterial growth. Every time that the line is disconnected opportunist bacteria will get in.

Also because of the high dextrose content the lining of the lumen of the PICC becomes very viscous. therefore you may get particulate adhering to the walls of the lumen of the PICC and the next med that you give is not compatible with the first one that you gave and reacts causing precipitation in the lumen.

So it is not ideal to stop and start TPN. Once a lumen of a PICC has been used for TPN at all it cannot be used for anything else. If your TPN runs out or expires before the next bag is available the recommendation is to run a bag of 5% dextrose TKVO and maintain the sterility of the giving set.

[IVRUS, BSN, RN]

TPN has a high level of dextrose anywhere between 11-25%. The problem with this is that it is a great media for bacterial growth. Every time that the line is disconnected opportunist bacteria will get in.

Also because of the high dextrose content the lining of the lumen of the PICC becomes very viscous. therefore you may get particulate adhering to the walls of the lumen of the PICC and the next med that you give is not compatible with the first one that you gave and reacts causing precipitation in the lumen.

So it is not ideal to stop and start TPN. Once a lumen of a PICC has been used for TPN at all it cannot be used for anything else. If your TPN runs out or expires before the next bag is available the recommendation is to run a bag of 5% dextrose TKVO and maintain the sterility of the giving set.

Actually, most of the time, the dextrose in TPN is 50 to 70%. Yes that is "heavy duty" sugar, and yes, bacterial love it.. So one should be concerned with infection control issues, but also incompatibilities. Ideally, the lumen used for TPN should be TPN dedicated only. No blood draws, or other IV medication should be piggybacked into this line. And if the TPN runs out, before your next bag is to you, the standard is to hang a Liter of D10, not D5W, and hang it to run at the same rate as the TPN, not KVO.

[NicuGal, MSN, RN]

Also because of the high dextrose content the lining of the lumen of the PICC becomes very viscous. therefore you may get particulate adhering to the walls of the lumen of the PICC and the next med that you give is not compatible with the first one that you gave and reacts causing precipitation in the lumen

Can I ask where this information is from? In NICU, we almost exclusively use single piccs and we don't have a choice but to use it for TPn and meds. I have not seen one clot off for this reason above. If you are flushing, and many meds ARE compatible with our TPN, there shouldn't be a problem.

[IVRUS, BSN, RN]

Also because of the high dextrose content the lining of the lumen of the PICC becomes very viscous. therefore you may get particulate adhering to the walls of the lumen of the PICC and the next med that you give is not compatible with the first one that you gave and reacts causing precipitation in the lumen

Can I ask where this information is from? In NICU, we almost exclusively use single piccs and we don't have a choice but to use it for TPn and meds. I have not seen one clot off for this reason above. If you are flushing, and many meds ARE compatible with our TPN, there shouldn't be a problem.

I can image that those neonates don't have vessels large enough for anything but a Single Lumen 1.9/2 French IV catheter, however, that does cause other issues, like an increase concern for precipitates and infection.

Biofilm (organisms which collect inside the IV catheter and create a slime covering) inside the IV catheter will be increased with the high glucose infusion, and it's difficult to prevent this completely. But, maintaining good techniques with hub cleaning and mantenance will decrease microbial formation/contamination. In these instances when one has no OTHER option but this SL catheter... Care for it well, and flush it well between the infusions and reconnections. Change you needleless injection caps daily, as well as the IV bag and IV tubing. And use a BIOPATCH, antimicrobial disc as part of the routine sterile drsg change procedure.

[AgentBeast, BSN, RN]

Many of the picc lines these days are impregnated with antibiotics, yet this is not a replacement for good technique and common sense.