TPN - Peripheral vs Central

We consider several factors, including osmolarity, calcium content, and dextrose content. Those are the ones I know of, but the pharmacy deems what can be infused where.

We generally just look at the concentration of Dextrose as anything above 10 percent should be given centrally otherwise it will scleroze the vein. I say generally b/c we will not even use a peripheral for PPN anymore unless it is just for a very short time (24hrs or less) until we can get a PICC in. The PIV sites just do not last long and require constant re-siting and the goal should always be vein preservation.

As a general rule, my unit goes by anything D13 or less can be given via peripheral. However, not too long ago during my safety checks at the beginning of my shift, I noticed that my baby had TPN hanging via a peripheral line that was D12, but had so many other additives that the osmolarity was high enough that pharmacy had written "Give via Central Line Only", but this had been overlooked by the nurse hanging the fluids since we allow up to D13 to be hung. Yikes.

anything over D12.5 goes central, and we do look at osmol. of the fluids.

We will infuse D12.5 TPN or lower concentration via peripheral line. Anything else requires a central line.

We do infuse TPN with Dextrose 12.5% and below via peripheral line and higher than that should be infused via central line.

Yes, we look at both dextrose concentration, calcium, and osmolarity. 900 osmoles or less for PIV. Dextrose 12.5% or less for a PIV.