rinne

Hi, Just ran into similar question yesterday evening when I went to pull down a completed KCl line and was surprised to see it running into the TPN line. It had been running at y-site on its own pump rate but I was concerned nonetheless. Was taught that nothing is run into TPN line. We called pharmacy and were told it's compatible, with no mention of the "golden TPN rule." Yes, TPN already has K in mix so that makes sense, but still was hesitant. Checked with my manager and she asked about rate of TPN (70 ml/hr), pt with no fluid overload issues, so combined rate of 170 ml/hr seemed reasonable. Home this morning, checked online and ended up here and then to site recommended by one of previous responders. Copied below for reference. Hope it helps. Learning experience and didn't have to consider whether incident report was necessary :-) rinne From http://healthlinks.washington.edu/nutrition/section6.html D. Medications and Parenteral Nutrition Administration of medications via PN may be beneficial when there is limited venous access and/or the patient is fluid restricted. The major problem associated with the addition of medications to PN is the potential for incompatibilities. The following issues should be considered if a medication is to be added to PN. Certain medications should not be mixed with any PN if intermittent infusion is necessary to achieve therapeutic serum levels (i.e. antibiotics). Medications that require a precise rate of infusion (i.e. cardiovascular agents) are not recommended to be added to PN solution. Doses of a medication cannot be readily adjusted once combined with the PN. Adding alkaline medications to PN admixtures may increase the potential for calcium-phosphate incompatibilities. Medication must be chemically stable in PN solution for over 24 hours. Medications routinely added to PN solutions include: H-2 antagonists (e.g. ranitidine) and insulin. The use of Y-site or piggyback drug delivery has helped prevent or avoid drug compatibility problems. The contact time of multiple solutions being administered via Y-site is short, often in the range of 15-20 minutes. There are many studies documenting the compatibility of PN and medications when administered via Y-site injection. Call the IV pharmacy for a complete list of medications that are compatible with PN and lipids.