Published Feb 12, 2004
Everywhere I've practiced, the policy has been that TPN/lipid has its own separate IV line and it's not to be used for anything else, not to be disrupted for bld draws, other IV meds, CVP readings, etc to avoid contamination/infection. I was talking to a friend whose hosp practice differs. I've been trying to pull up research articles on the subject, but having trouble with my medscape account. Any articles or practices/policies would be appreciated. Thanks.
Why not have a seperate line normally you have three why do you need to stop the TPN.
The only time I could think of is if a patient has the misfortune to have a single lumen PICC...
Most patients of mine have triple lumen caths and i utilize one for the TPN....one for fluids and one for a blood draw......unless its like a BMP then I draw my labs from the opposite side /arm...bc you have to waste like 30cc even if you stop the tpn for 10 min and draw from another lumen to avoid errored/wacky lab values d/t the tpn/lipid.
The only infusion I have combined with TPN is albumin drip ...in a real pinch when the patient was on a load of vasoactives, unstable and with limited access. We were waiting for our PICC nurse and I had run out of options...not a 'best practice' but in real life we sometimes do what we have to. Pharmacy and surgeon supported me in this particular circumstance altho it is against my policy perse. Following facility policy as much as humanly possible is always the best advice, but occasionally we must 'think outside the box' as it were (and I hate that cliche but it seems to apply in some critical situations. ..lol).
The way we handle it is this....TPN must be given through a central line, which is "virgin" (never used for anything else) and must not be used for anything else after infusion begins. Also, it should be stopped as little as possible, once infusion begins.
However, in the case of an emergency, why not leave it off for a while until a new line can be inserted? or am I remembering the situation incorrectly? hmmm
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