TPN help

[C-anne123]

Help, new grad here. First day and my patient is on TPN which I have never dealt with before. I come in to do my safety checks first thing and notice his TPN line which should be connected to his IJ has become disconnected and is just infusing into the bed and has soaked the bed. The charge nurse came in and asked what the matter was so I told her and told her that I was going to clean both the central line port and the connecting port on the tubing and reconnect it. I also informed the educator and doctor of this. The educator said it's not ideal but there was no real correct way of dealing with it because our new bag wouldn't be coming up for another 10 hours and if I had left it disconnected he would have gone all day without nutrition. At shift change I found out that pharmacy actually sticks just generic bags of TPN and according to the incoming nurse I should have gotten one of those and spiked a whole new line and set. I know I told everyone I was supposed to be I'm so worried that I may have harmed this patient now. I will probably go speak to my educator again when I'm next in but any thoughts on this situation?

[Triddin]

I think you're fine. Unless the generic tpn bags are identical to what the patient is prescribed, you would likely do more harm that way with a different formula.

You can also infuse d10 if your tpn bag is compromised

[K+MgSO4, BSN]

No, no, no.

Never reconnect a bag of TPN that has been disconnected and infusing into.a bed!!! It is a bacteria festival in that delicious high glucose solution and you are reconnecting to a CVAD, thus putting the pt at risk of a CLABSI.

Call sterile pharmacy and get a new bag made up, call the doctor and get a new order.

[blondy2061h, MSN, RN]

No way would I EVER connect any tubing that had been in a bed to any type of IV much less ton to a central line. The infection risk is huge here. You get an order to infuse d5 or d10 at the same rate as the tpn, monitor glucose levels, and wait for the new bag. 10 hours is not that long to go without nutrition and a far lower risk than sepsis.

[AnnieOaklyRN, BSN, RN, EMT-P]

As an IV nurse I would have written you up if I found out you did that!! Realize that TPN is a lovely place full of nutrition for any bacteria and other microbes to grow, which means as the end of the open tubing is sitting on the bacteria and fungal covered bed and where ever else it may have gone, including the floor and you just plugged it back into a central line?!!!

Sorry, but you are clearly lacking in critical thinking skills and you need to work on that. The patient is better off without their TPN for a few hours then they would be with sepsis and the need to remove their central line or port. Please use some common sense... any tubing, whether it is TPN or just NS that goes un capped without you controlling where the end goes needs to be completely replaced. I see a lot of nurses just plug the end into the first IV port, which can also result in infection. The end should be capped. This goes for PIV as well.

Sounds like your educator needs some educating as well! There is a correct way to deal with this! You don't plug it back in, your throw it out, and then monitor the patient until a replacement bag comes up!

Annie

[iluvivt, BSN, RN]

An entirely new set up is needed with a .22 micron filter and add on filter is needed.The needleless connector (NC) then needs to be scrubbed with IPA for 20 to 15 seconds and flushes until you are ready to resume something through it.Any patient receiving PN,especially the lipids is at increased risk for catheter related blood stream infection and also fungal infections especially candida.The lipids bump up that risk.Unfortunately, the way you did it was unacceptable. Did you just scrub the end of the IV tubing?You must also try to figure out how this happened to prevent it from happening again.You may want to actually change the NC if it lead to the disconnection...it's rare to be defective but could be.Did the pt pull on it.Was it not luer=locked on correctly.Was the tubing secured to the pts skin so the tension is off the insertion site of the CVAD.While you can administer PN through an IJ it's better to get a PICC line.The use of the IJ depending on how long it's been in also increases the risk.

[Night__Owl, BSN, RN]

You did the right thing asking your charge nurse, educator, and doctor about what to do since you weren't sure. And any one of those three (first two especially) should have known the right way to steer you. Unfortunately, they did not.

Some of the previous posters in this thread are being surprisingly harsh on you, considering you did all the right things, and were simply given the wrong answer.

Don't beat yourself up. Keep asking for help when you aren't sure how to proceed. But protect yourself also. If you are acting under guidance of the charge nurse or any other superior, write that you "spoke with charge nurse, agreed to do X" . Hopefully this is a one-off occurrence for your charge nurse (and your educator,) but if nothing else, to keep yourself from being thrown under the bus because someone else led you wrong.

[rockyroad#]

She is a new nurse and it seems as if she wasn't thought the protocol. What she did was wrong, but didn't know the right way. That the problems with hospitals putting new nurses on the floor without proper training. I was trained for three months on the floor and now they are trying to put new nurses on the floor within a month. Blame the hospital!!

[lhflanurseNP, APRN]

Can someone explain why this is still in the Student Nurse Practitioner area?