TPN question

TransplantRN3 · Nov 3, 2011

I work on a very specialized pediatric unit. Almost half of our children are on TPN and lipids. It is normal practice for us to run compatible fluids in the same lumen as the TPN and lipis- we do it all the time as long as the fluis are compatible.

babyNP., APRN · Nov 3, 2011

Yeah, that's odd; we always run other stuff with our TPN/IL.

All compatible meds, various drips (sedation and pressors), replacement fluid if the kid is dumping out of an ostomy, etc etc.

And try putting in a double lumen PICC into a 750 gram micropreemie, heh! No chance!

NicuGal, MSN, RN · Nov 3, 2011

We run anything compatible with our TPN/IL. There are some things that aren't compatible with the IL, so we dc them until we can run them. I'm sure it is the same for adults, but with adults you may have more lumens to pick from, but it isn't wrong to do run things with TPN.

elthia · Nov 4, 2011

Why they waste their time putting in only a single lumen PICC drives me crazy sometimes. If you're going to place a central line, might as well have more than one lumen.

Sometimes in chronically ill pts or pts that have bad vascular disease it is hard to put in multiple lumen PICC line, especially if it is a power PICC. At least that is what I have been told.

Mommy&RN, BSN, RN · Nov 4, 2011

If at all possible, TPN/Lipids are on a dedicated line/port.

If your guy was messing with the PIV and you took it out, guess where he would go next. (Not saying what he was doing is okay, but... better than him messing with the PICC)

IVRUS, BSN, RN · Nov 4, 2011

We run anything compatible with our TPN/IL. There are some things that aren't compatible with the IL, so we dc them until we can run them. I'm sure it is the same for adults, but with adults you may have more lumens to pick from, but it isn't wrong to do run things with TPN.

WOW, TPN lines need to be dedicated to nothing but the TPN... putting anything else into the same tubing should be a very RARE exception, and not the norm. Your organization needs to check into ASPEN (American Society of Parenteral and Enteral Nutrition) standards. You and your organization should worry about Compatibility, infection prevention and stability of your solutions... These standards apply to kids, as well as adults.

Your organization is looking for a lawsuit.

poopprincess · Nov 4, 2011

I was taught TPN/Lipids run solo with their own port. When we do labs, we stop it for 15 min. and flush with 20 ml. before drawing. We also try not to pull lines from that port, but we will if it is a last resort.

I also thought single luman PICCs were stupid! I asked the PICC line nurse and it was explained to me that the number of lumens is directly associated with the size of the vein that they use. So people with single lumens have it in a tiny vein that couldn't handle anything bigger. :)

IVRUS, BSN, RN · Nov 4, 2011

I was taught TPN/Lipids run solo with their own port. When we do labs, we stop it for 15 min. and flush with 20 ml. before drawing. We also try not to pull lines from that port, but we will if it is a last resort.
I also thought single luman PICCs were stupid! I asked the PICC line nurse and it was explained to me that the number of lumens is directly associated with the size of the vein that they use. So people with single lumens have it in a tiny vein that couldn't handle anything bigger. :)

Stopping for 15 minutes is NOT necessary. With a blood flow of around 2000cc/min in the SVC, all you need is a full minute then draw your specimen. Standards also say that all catheters should have the LEAST amount of lumens. Catheters which are multilumened, have much higher infection issues.

JemJ · Nov 4, 2011

Hi! Umm - OK, we run insulin with our TPN, as many times there is insulin in the TPN already, especially if we are short on ports. Also, I was always taught you could run propofol as it's lipid based with TPN. Thoughts?

poopprincess · Nov 4, 2011

IVRUS, I wish my facility would agree with you! Sure would save me a lot of time in the mornings, especially when I forget to cut it off. lol

NicuGal, MSN, RN · Nov 4, 2011

IVRUS, think that is a bit harsh. Maybe you should pick up a Neofax or peds IV compatibilty chart and see that there are many things compatible with TPN, esp in the neonatal and peds world. Maybe spend a day in a NICU and see what we are dealing with. I can also tell you that we have near ZERO line infections for almost 3 years now since we began a central line bundle. and rarely have sepsis due to staph because we aren't starting separate lines all of the time. And to say we are looking at a lawsuit, probably not if we have the proper guidelines and research to back it up. If we have meds that the above sources say are not compatible, then yes, we will start a separate line, but obviously you have never worked with a neonate that has limited access and is too small to put mulitlumens in, except for a double lumen UVC, which can really only stay in 10 days max. I respect that you are an IV nurse, but you are wrong, esp in the neonate and peds world. Using a dedicated line in an adult is fine, but these kids are not the same.

Some examples from hospitals/reference books.

http://www.uihealthcare.com/depts/med/pediatrics/iowaneonatologyhandbook/pharmacology/nicuintravenousdrugc.html

http://books.google.com/books?id=1e2-yggGeUIC&pg=PA991&lpg=PA991&dq=medication+compatibility+with+TPN+in+neonates&source=bl&ots=ekhyyDs3ow&sig=Elw31TZVAO45dkDkl0g7HY3tPdg&hl=en&ei=8120TozXIMHnsQK6mPjJAw&sa=X&oi=book_result&ct=result&resnum=10&ved=0CFgQ6AEwCQ#v=onepage&q=medication%20compatibility%20with%20TPN%20in%20neonates&f=false

IVRUS, BSN, RN · Nov 5, 2011

IVRUS, think that is a bit harsh. Maybe you should pick up a Neofax or peds IV compatibilty chart and see that there are many things compatible with TPN, esp in the neonatal and peds world. Maybe spend a day in a NICU and see what we are dealing with. I can also tell you that we have near ZERO line infections for almost 3 years now since we began a central line bundle. and rarely have sepsis due to staph because we aren't starting separate lines all of the time. And to say we are looking at a lawsuit, probably not if we have the proper guidelines and research to back it up. If we have meds that the above sources say are not compatible, then yes, we will start a separate line, but obviously you have never worked with a neonate that has limited access and is too small to put mulitlumens in, except for a double lumen UVC, which can really only stay in 10 days max. I respect that you are an IV nurse, but you are wrong, esp in the neonate and peds world. Using a dedicated line in an adult is fine, but these kids are not the same.
Some examples from hospitals/reference books.
http://www.uihealthcare.com/depts/med/pediatrics/iowaneonatologyhandbook/pharmacology/nicuintravenousdrugc.html
http://books.google.com/books?id=1e2-yggGeUIC&pg=PA991&lpg=PA991&dq=medication+compatibility+with+TPN+in+neonates&source=bl&ots=ekhyyDs3ow&sig=Elw31TZVAO45dkDkl0g7HY3tPdg&hl=en&ei=8120TozXIMHnsQK6mPjJAw&sa=X&oi=book_result&ct=result&resnum=10&ved=0CFgQ6AEwCQ#v=onepage&q=medication%20compatibility%20with%20TPN%20in%20neonates&f=false

Don't mean to be harsh on you, but rather being harsh on policies which are accepting something different than standards put forth by experts in the field of Infusion and Parenteral Nutrition. This was NOT a slam against you as you are following P&P of your employing institution. I'm just saying that I know that paradigm change is hard, especially if "We've always done it that way" is prevelant, but I still contend BEST PRACTICE needs to be revisited. Yes, drugs may be physically compatible with the TPN solution, but then this isn't, as I previously noted, my, and the only concern. We can, however, agree to disagree.