Preparing TPN

Originally posted by Slightly

Hello all,

I have a few questions about preparing TPN.

1. Do you dress sterile when changing TPN sets ? (robe, gloves, mask etc.)

2. Do you change sets alone or does it require 2 nurses ?

3. Do you use Povidone-Iodine connectors at the junctures ?

4. Do you change the whole tubing when changing the TPN sets ?

5. Do you change sets and tubing each time you change TPN transfusionbag ?

6. How often do you change the TPN transfusionbag ?

7. Do you use opaque sets and tubing ?

Thanks so much

Lia, Kaplan Medical Center, Israel

I will try to answer your questions by using what we have in our policy where I work.

TPN is made in 30% or 50% dextrose bottles so It may or may not apply to you.

We do not Dress sterilely although sometimes I wear a mask when I am dealing with a central line in a high risk pt.

We change TPN by ourselves as RN's but LPN's can't change TPN. I don't know why.

WE don't use iodine, we use alcohol

WE change the TPN set at least q 24 hrs if not more. If the next TPn is going to run more than 24 hrs on the tubing, we change the tubing and we label it always.

TPN hangs for 24 hours only.

WE do not use opaque sets, we use an opaque wrapper around the TPN and only if it has MVI (multi-vitamin infusion) in it.

I hope this answers your question from my perspective.

Welcome to the Board!

Melissa

edited to add I didn't realize that you were talking about Neonatal TPN. My post is relating to Adult TPN.

1. Do you dress sterile when changing TPN sets ? (robe, gloves, mask etc.) No we don't.

2. Do you change sets alone or does it require 2 nurses ? We change it by ourselves, just like any other fluid.

3. Do you use Povidone-Iodine connectors at the junctures ? Yes..we always clean before hooking up.

4. Do you change the whole tubing when changing the TPN sets ? Yes.

5. Do you change sets and tubing each time you change TPN transfusionbag ? Yes.

6. How often do you change the TPN transfusionbag ? Every 24 hours

7. Do you use opaque sets and tubing No, regular tubing...we don't cover anything.

Just wondering why you would use a sterile procedure since everything is contained and the inside of the tubing is sterile? KWIM?

hi dawngloves,

What do you mean by "everything is contained" ?

The pharmacy supplies the TPN transfusionbag and we connect it to the IVAC set and the extension tubing ....this is the way it is done here...

Well you pull the tab off the IV bag and then spike it so you never touch the inside of the bag or the tip of the IVAC. And then again the connector cap is covered and you never touch that or the inside of the line you are connecting it to.

Kinda hard to explain but nothing ever becomes "dirty" as far as I can see.

dawngloves,

I see what you mean, but, the routine here is handling it with a sterile procedure.

I don`t find it rational neither, this is why I posted the question :)

:chuckle Thank you! I was though maybe I was dense or something! I just didn't get it!:kiss

At our hospital, Pharmacy connects the tubing to the bag under the hood, and then we just connect to the line-I wear a mask and use standard sterile precautions when breaking into the line.

But why?Really, I'm not trying to smart, but is there something I don't see here?

You are never coming in contacted with either end of the line. And I don't see the point of wearing a mask or laying down sterile drape. It takes me about 5 seconds to disconnect and reconnect tubing. Is something going to jump off of the blankets into the tubing? Do you have to wipe the entire legnth of the line with Betadine before you disconnect to prevent anything from traveling into the line?

I know you are just following policy here, but doesn't anyone ask "Why"?

Originally posted by dawngloves

But why?Really, I'm not trying to smart, but is there something I don't see here?

You are never coming in contacted with either end of the line. And I don't see the point of wearing a mask or laying down sterile drape. It takes me about 5 seconds to disconnect and reconnect tubing. Is something going to jump off of the blankets into the tubing? Do you have to wipe the entire legnth of the line with Betadine before you disconnect to prevent anything from traveling into the line?

I know you are just following policy here, but doesn't anyone ask "Why"?

I totally understand what you're saying here...where I work, if it's a central line, we are supposed to do a completely "sterile" tubing change, sterile gloves, mask, etc, but if it's a peripheral line, we don't. Has always been confusing to me, 'cause I'd never heard of this before. I was told by my preceptor that it's an "infection control" practice...?

We do not use betadine/iodine however, b/c it has been shown that it has no effect on plastic,but we are supposed to use alcohol and wait 30-60 sec for it to dry, however.

Interesting topic!

Where I work, we use sterile sheet and gloves, both with peripheral and central lines. We do it alone. We don`t use povidine connectors (some places do). We change the whole tubing when changing the bag, every 24 hours, lipids too. We don`t use opaque sets.

Thx for your cooperation.

Lia

Interesting thread. I work LTC and have a few res on TPN (lipids already added, we add MVI) Central line port cleaned with alcohol swab, tubing connected and then started like any other IV infusion. TPN and tubing changed q 24 hrs (most just on TPN for 12hrs) No sterile dress, one nurse and no covering over the bag. I realize the ICU is different...but just wanted to add how its done in the home setting.