TPN and Ceftriaxone

FutureNurse2B · Dec 18, 2009

Yes, that seems correct to me. You really are not supposed to stop the TPN for any reason b/c of the risk for hypoglycemia but if the child needs an antibiotic what else can you do. I have been taught to simply stop the TPN, flush the line, give the drug, then flush the line again. So yes, I would do the same. : )

noreenl · Dec 18, 2009

Sometimes my older patients get a heplock as a secondary access for time frame of the ceftriaxone so that the TPN is never stopped. That is the only other real possiblity As for the central line I would also use a different port on the triple lumen all together so that there is no possiblity of cross contamination at the CVP Site itself.

littleneoRN · Dec 20, 2009

Well if you have multiple lumens, there is no need to stop the TPN as the ceftriaxone can just go in an alternate lumen. Unless you just mean a different tail on a trifuse? I might not be reading this the same way you mean it. :specs:

noreenl · Dec 22, 2009

if two medications are not "Y compatible" then you cannot run them at the same time into two different ports in the same central line access site. All the lumens go to the same central line so they would be mixing and if they are not compatible you just destroyed a perfectly good central line and your patient may be forced to endure another central line placement at a different site. You only have two possible femoral sites the it can go to the subclavian which usually freaks out patients. Something about a "huge catheter" in their neck is intimidating to some patients.

Pediatric Critical Care Columnist · Dec 22, 2009

if two medications are not "Y compatible" then you cannot run them at the same time into two different ports in the same central line access site. All the lumens go to the same central line so they would be mixing and if they are not compatible you just destroyed a perfectly good central line and your patient may be forced to endure another central line placement at a different site. You only have two possible femoral sites the it can go to the subclavian which usually freaks out patients. Something about a "huge catheter" in their neck is intimidating to some patients.

That is not true. Multi lumen central venous lines have completely separate lumens that exit the line at different spots along the side of the line with the largest lumen usually opening at the proximal tip. They infuse into large vessels with rapid, high-volume blood flow that does not allow physical mixing of incompatible meds. Catheters used for hemodialysis and continuous renal replacement therapy have two large lumens that allow the aspiration of blood from one lumen and the infusion of blood into the other. It would seem somewhat counterproductive if the contents of the two lumens mixed inside the catheter in those circumstances now wouldn't it?

noreenl · Dec 22, 2009

what pictures are you showing me? I was always told that if 2 "fluids" were not y compatable that they could not go in the same line at th same time. i was always under the impression that this included CVP lines with different lumens (ie. triple lumen catheter) I can remember having my HIV patients getting TPN and multiple antibiotics having to have a second site even thou one of the site was a tripl lumen CVP> Maybe just being overly cautious? learn something new everyday!!

Pediatric Critical Care Columnist · Dec 23, 2009

Those pictures are cross-sections of two different types of multi lumen CVCs. The idea was to show how the lines are designed with the lumens completely separate from each other. That essentially means that the line isn't a single line, it's three lines. I've worked in PICU for more than 12 years and we run incompatible solutions into our lines all the time, as long as they're in different lumens. The only access we may have in a child is a triple lumen CVC through which we could be running TPN and lipids in one lumen, epinephrine, norepinephrine, milrinone, morphine, and midazolam in another and furosemide in the third. The furosemide would be stopped and flushed for antibiotic or other incompatible med infusions. I'm not sure why your HIV patients would need a second site for antibiotics unless they had something else running into one of the lumens that couldn't be interrupted. Our transplant patients often have tacrolimus (which doesn't play well with others) in one lumen and ATGAM (which MUST run alone) in another. If we need to give meds and have no other access it will be into the lumen with the TPN... which jacks up their infection risk hugely. Some meds are compatible with TPN and lids and we have a list of them so they can be run together. Not ideal but then a lot of what we do is under less-than-ideal conditions.

littleneoRN · Dec 23, 2009

Y site compatible means it's ok to go in a single lumen line with a bifuse (or more-fuse :) that makes a "Y" near the patient. This means the medications are ok to run into the same line since their time together will be brief, as opposed to being compatible to be mixed and stored together for a longer period of time. You can treat additional lumens like completely separate lines. Just make sure you know whether you're dealing with separate lumens or just a y-site! :)

noreenl · Dec 23, 2009

OK.Thanks for the refresher!! I appreciate the time you took to keep answering my questionsCause that's what this site is all about!!! I tried to google info and I got swamped like those commercials on TV (Bing ad I think) where the people use the search word as a basis for TMI too much information!!

If you could, can you point me in a direction to get info in writing to back me up when I am teaching my students. Thanks again!!! Happy holidays!!!

Pediatric Critical Care Columnist · Dec 23, 2009

Here's a link to a critical care forum study into the infusion of incompatible solutions (TPN and phenytoin - the great killer of IV access!) via multi lumen central line. It revealed no particulate matter of clinical significance. http://ccforum.com/content/3/1/51

Another report on the simultaneous infusion of pH-incompatble solutions via double lumen catheter:

http://www.theannals.com/cgi/content/abstract/32/9/875

This product utilization guide includes a description of a double lumen peripheral catheter that allows simultaneous infusion of two or more incompatible infusions on page 8:

http://www.mayohealthcare.com.au/products/pdf/cardioVas/trm-c1200.pdf

There's some limited information in this CEU package:

http://www.nurseceusonline.com/viewcourse/20-53217.htm

This is a fairly comprehensive educational package from a major line manufacturer. The infusions section starts on page 31:

http://www.arrowintl.com/documents/pdf/education/ml-ng1201.pdf