TPN and meds

CritterLover, BSN, RN · Jan 26, 2007

it all depends on facility policy.

however, i have never seen a hospital that ok'd infusing anything into tpn, other than lipids.

homecare is a different story. i had a patient once who had a port a cath. he was getting tpn, dilaudid pca, and levaquin (and possibly vanc, too, though i don't remember anymore) all into the one port.

i looked at the pharmacist like she had two heads when she told me this was ok, since i had always been taught that nothing can be infused into the same line as tpn.

turns out, this is an infection control issue, not so much a compatability issue. many meds are compatable with tpn. it just isn't generally considered "safe" to infuse things into it because violating the line sets the patient up for infection, as tpn is an excellent medium for bacterial growth.

my homecare patient got all of this stuff together for a couple of weeks, never had a problem with it.

bottom line: it all depends on facility policy, not just compatability.

meownsmile, BSN, RN · Jan 26, 2007

I really wouldnt piggyback or ysite an antibiotic. However, a potassium or magnesium rider can easily be piggybacked into a TPN.

NessaNurse · Jan 26, 2007

Wow..at our facility we use syringe pumps to place mlutiple meds into a Y site, as long as they are compatible you are good to go really.. Some meds are compatible with lipids as well. If something is not compatible with TPN you can stop the TPN, flush the Line (The CVC, not the TPN line, use a spearate one!)and run the meds *(as long it is not longer then 15 min, longer than that and the patient may bottom out sugar wise, this can also depend on the pt, some pts botton out in less then 15 min.).

And yes TPN is an excellent medium for bacterial growth but when your line is your only access and you are runing meds that run for over an hour and ARE compatible, you can run them with TPN..you can check your med books or with pharmacy for compatibilties.

allnurses Guide · Jan 26, 2007

I was always taught not to piggyback any meds with TPN (I know some ICUs do this, but I'm talking a general medical floor). However, today I saw a nurse (I'm a student) connect a med at the y-site with TPN and she said that was ok, although she added "never a piggyback the ABX into the TPN." My question is: what's the difference? If you piggyback OR if you y-site connect, the fluids are going to mix with each other a bit. So why is one ok (y-ing it in) but the other (piggybacking) is not ok?
ps-I know you never wanna run any meds with lipids

ICU occassionally will run meds with TPN, but most prudent nurses will call and speak with the pharmacist first to see if there will be compability problems. The pharmacist(s) has told me in the past it has mainly to do with pH differences. In general ICU nurses try hard not to run anything with TPN, but sometimes it just isn't possible.

Also, it doesn't matter if you piggyback it or y-site it still runs together...there is no real difference.

nurseklw72 · Jan 26, 2007

Please tell me you are piggybacking meds onto TPN below the filter! Otherwise, most of your medication is floating around in the filter. As a practice, I do not mix anything in the TPN. Patients with TPN usually have central lines with more than one lumen so I usually set up a maintenance line also.

bobq219 · Sep 15, 2008

kk...

There is a difference between y site and piggyback...that difference is that you are controlling the rate of infusion seperately from the rate of infusion of the tpn. This counts a lot, especially when infusing mag or K+.

Know this is an older thread but just found it so hope this answer helps.

blondy2061h, MSN, RN · Sep 15, 2008

We never run anything with TPN.

iluvivt, BSN, RN · Sep 16, 2008

Because of the high Dextrose content in TPN It is an ideal medium for bacterial growth.especially Candida. Therefore TPN should be a dedicated lin or lumen for TPN only. It is OK to add Lipids t the bag for a 3 in 1 product or have a seperate infusion piggybacked in. The CDC recommendation is that it be a dedicated line. Infusion Nurses Standards recommend this as well. Sometimes in very special situations you can add some medications as a piggyback. I remember one patient that we only a single lumen PICC and no one could get any other line in him. So we piggybacked some KCL and shut off the TPN for a very short time to administer his Abx, Thie is the exception rather than the rule. Now we have Ultrasound and can easily repalce the PICC if more lumens are needed.

th468 · Sep 7, 2010

is it acceptable to run tpn and other iv medications such as antibiotics via a PICC line if there are multiple ports? example tpn continuous via one port, intermitt. drugs through the other at the same time

qt_rn · Sep 7, 2010

The nurses I work with have always called pharmacy to make sure the meds were compatible. For someone who is NPO and needs extra fluids, we have the lipids piggybacked to the tpn line, then a line of ns hooked up to the y using a separate pump. Our pharmacy has told us it is OK to run panto through the line with ns while still y'd to the tpn, however I would stop the pump that is running the tpn during the panto infusion. This pt has a single lumen picc and my thoughts about running a med during tpn with a single lumen was that there should be less chances of infection because you are not constantly unhooking and hooking up a line to the picc.

I don't have an answer to your question about why it is OK to do the y and not the piggyback, I am interested in this as well! Someone mentioned the filter and the meds not making it through the filter, which makes sense to me!

blondy2061h, MSN, RN · Sep 8, 2010

is it acceptable to run tpn and other iv medications such as antibiotics via a PICC line if there are multiple ports? example tpn continuous via one port, intermitt. drugs through the other at the same time

Yes. They are independent lines.