TPN compatibility

[DesertpedsRN]

I have a question about TPN compatibility. We have a patient with a single lumen CVC who is receiving triple antibiotics....Ampicillin, Gentamicin and Vancomycin. I know Amp isn't compatible but there is conflicting info regarding Vanco and Gent. I say they all aren't compatible because the pt has a single lumen catheter. Even if you used a y-site it doesn't matter you have to stop the TPN to administer the antibiotics. Any input would be much appreciated. Thx!

[sapphire18]

I've never worked anywhere that allowed anything to be run with TPN. You need more access.

[KelRN215, BSN, RN]

If they're compatible you don't have to stop the TPN.

[turnforthenurse, MSN, NP]

I was taught to never piggyback or y-site something into TPN. I agree, you need more access. Also, I hate it when providers put in single lumen central line - what's the point??? AT LEAST make it two lumens.

And you shouldn't be stopping and restarting the TPN for the abx, either. The vanc needs to be run at least over an hour, sometimes longer depending on the dose/concentration. Not sure about the other two off the top of my head. Stopping the TPN cold turkey can cause hypoglycemia. That's why places generally have a policy of hanging D10 if TPN isn't readily available.

[nurseprnRN, BSN, RN]

1) TPN has a high glucose content, not cool to be stopping and starting, especially for an hour at a time or multiple times all day and night; over 24 hours that will also short the patient on the intended nutrition.

2) The reason you hear that you don't run antibiotics with TPN is not because they are incompatible, it's because you can't run them in the same lumenfor infection control purposes, because you can't be breaking into a TPN line all the time. Start another lock for antibiotics or get the provider to start a 2- or 3-lumen line.

[Shanua]

In a perfect world you would have more access. On very rare occasions we run Vanco or other compatible antibiotics when pharmacy approves it and a physician okays it. We do have on patient who is no longer a central line candidate and can longer get peripheral access that has a port for this reason. When this person comes in, they are generally on TPN which the physician writes an order to stop and run antibiotics. There is one, we run it over 15-30 minutes and hook the TPN back up.

I was always taught never to run anything with TPN but you are taught the perfect world. Which it's not always.