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..........

[K+MgSO4, BSN]

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.

Sorry, yes not sure where i got the numbers for the dextrose content. shouldn't have the laptop and TV going at the same time!

[blondy2061h, MSN, RN]

We use a ton of TPN, and it is not our policy to designate a lumen for TPN. For starters, after TPN is discontinued, what are we suppose to do, never use that lumen again? Some of our antibiotic orders are to rotate the lumen infused on each dose. We often get orders to obtain blood cultures from every lumen, etc, etc, etc. It's just not realistic to designate a lumen for TPN all the time.

[NicuGal, MSN, RN]

@IVRUS: We have instituted central line bundles with a huge re-education and we have been infection free for 18 months. We only use single lumens, even in the groin, that is why I am questioning this. We change our dressing once a week, use bio-discs on kids over a kilo, we also only change our tubing every 3 days, along with the caps. We also have a closed medication line that is attached to the trifurcated filter, which is also changed every 3 days.

That is why I was asking, if we can keep a line infection free and not clotting off from giving meds thru that line with our TPN (yes, we IVPB many meds into our TPN) then why it seems to be a problem with the adult world, unless it is the higher glucose concentration. We can go up to D20 or D25 on some of the bigger kids. We have also had lines in for months without a problem. Just wondering.

[qt_rn]

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

Yes, that's correct. This patient's TPN runs for 12 hours through the night so that she is able to be independent during the day for the most part.

Oh and to clarify on my post about running things with TPN and disconnecting, it depends on the med whether we disconnect completely from the picc or is we y site it, as our nursing educator taught us that there is potential for meds to get past the clamp and react in the tubing. On a usual night with this patient, they are only connected and disconnected once.

[IVRUS, BSN, RN]

NicuGal said:

@IVRUS: We have instituted central line bundles with a huge re-education and we have been infection free for 18 months. We only use single lumens, even in the groin, that is why I am questioning this. We change our dressing once a week, use bio-discs on kids over a kilo, we also only change our tubing every 3 days, along with the caps. We also have a closed medication line that is attached to the trifurcated filter, which is also changed every 3 days.

That is why I was asking, if we can keep a line infection free and not clotting off from giving meds thru that line with our TPN (yes, we IVPB many meds into our TPN) then why it seems to be a problem with the adult world, unless it is the higher glucose concentration. We can go up to D20 or D25 on some of the bigger kids. We have also had lines in for months without a problem. Just wondering.

Well, I would be concerned about a TPN tubing change of q 72, if Lipids were present, or in other words you have a 3 in 1 solution. A TNA, or triple admix that contains Dextrose, amini acids AND lipids, should be changed every 24hours. No lipids.. q 72 works.

Filter wise, use a 1.2 micron for 3 in 1 solutions, and a .22 micron with TPN without lipids.

I appreciate your low BSI's and your re-education with your central line bundles... And I pray it continues for you and your organization. 

[BittyBabyGrower, MSN, RN]

We do the same in our NICU as Nicugal....our lipids are run separately thru another lumen on our trifurcated, most NICU's do not mix lipids with tpn in the bag. We have followed CDC and IHI guidelines :)

We have had only 2 line infections in the past 20 months since we started bundles...our umbilical lines are at zero!