TPN/IL through UAC??

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Specializes in Neonatal Intensive Care.

Hi,

I was wondering if anyone works on a unit that routinely runs tpn and lipids through a UAC? and if so, do you run the lipids through the tranducer? The unit I work in doesn't use PICC lines near enough and we are finding that they are ordering the tpn and lipids to run for weeks through the UAC. I don't feel comfortable with this. You can't get a good wave form and pressure with lipids running through the third port. We were running lipids through the transducer:eek: and now are running them through the third port :eek: Any insight into this would be appreciated.

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Specializes in L/D 4 yrs & Level 3 NICU 22 yrs.

Good heavens! We NEVER run ANYTHING through a UAC except flush. I can't imagine infusing TPN or lipids through there! I doubt the transducer manufacturer would recommend that either.

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Specializes in NICU.

Um...no. Just UAC flush fluids and in a rare emergent case, resuscitative medications when no other access is available.

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Specializes in NICU, PICU, educator.

If we have no other access we will run TPN, but not lipids thru the transducer. UAC's should be ideally pulled after 7-10days.

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Specializes in Neonatal ICU (Cardiothoracic).

We sometimes run TPN or meds (no pressors) through out UACs when no access is available.

We are told lipids are NEVER to be run though UACs. I believe it has something to do with risk for lipid embolism.

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Specializes in Level III NICU.

We JUST had this conversation today about a baby that is a hard stick, couldn't get a UVC, only UAC and they figured we'd just advance feeds. Well, of course, the baby didn't tolerate feeds and is blowing through PIVs like crazy. We want a PICC, the medical team said to run fluids via UAC. The only time I've ever done so is in an emergency situation. Usually it's just heparinized sodium acetate/chloride.

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Specializes in NICU Level III.

I have run TPN through a UAC before because we could get no other access. No lipids.

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Specializes in NICU, Post-partum.

We do PICC's on every baby that is expected to be on TPN and LIPIDS for longer than 2 weeks.

They will not hesitate to go as far as a Broviac for serious cases where a PICC cannot be obtained and it's too late for a UVC.

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We do use UACs for TPN/IL administration but only if we have IV access issues. No, we do not run TPN/IL through the transducer because it clogs up the transducer and you cannot obtain a good wave form

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Hi,

As you have seen from all of the other answers almost no one puts anything but flushes through the UAC.

In our unit we still run TPN through the UAC, NEVER intralipids, and pull the UAC after 7-10 days.

Hope this helps

Adinad

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Specializes in Neonatal Intensive Care.

Thank you for all your input!

It's actually getting to the point where we are using the UAC more now than before to run TPN/IL We are having a problem with the NNP not being able to get the UVC. We had a discussion with the NEO and he basically said that PICC lines where more dangerous to use on kids than UAC to run TPN/IL. He stated that he doesn't see the point in putting the baby through a "time consuming" procedure for just a couple of weeks of TPN/lipids. We are running the lipids through the third port and not through the transducer...however, I still feel very uncomfortable with this. I have searched the internet for some literature on this (and possible fat embolism literature) but can't find anything. Does anyone have anything they can share with me?

Thank you!

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Specializes in NICU.

Once in 4 years I had to run TPN through a UAC and in NO WAY did we run lipids. It was our only access and we switched to clear fluids with lytes quickly. A CVL was placed the next day since PICC was just getting to be impossible. We insert PICCs almost all infants under 1500 grams.

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