TPN question

NeoNurseTX, RN · Nov 5, 2011

In NICU with run a lot of stuff with TPN/IL and piggyback IVFs into TPN.. but we change out the TPN and and all tubing running with anything with dextrose in it q24h. I'm not sure what is the "norm" on adults for changing lines.

MerylLee · Mar 10, 2020

I know this is an old thread, but was looking for some info on TPN and what can be run with it. I work in a step down ICU and had a patient with no PICC because of too much scar tissue (it was attempted twice, settled with a single lumen hickman port) and she also had a peripheral wrist 20 g. She was gettig TPN through the hickman and Vanco and zosyn through the PIV. Well now K+ is low, so I've got an order for 2 bags of potassium (no lidocaine or anything else). Ran that with saline in the PIV and blew the vein (shocking). Attempted to get another PIV and blew the vein ? So I recruited help from the US machine and some seasoned nurses who also informed me that TPN has potassium in it so I can run the potassium into the hickman port and run the TPN at the Y-site. I was ALSO taught that TPN should have a dedicated line but I was desparate and it worked well. We change out all the tubing and brand new tpn every 24 hours.

CritterLover, BSN, RN · Mar 10, 2020

33 minutes ago, MerylLee said:
I know this is an old thread, but was looking for some info on TPN and what can be run with it. I work in a step down ICU and had a patient with no PICC because of too much scar tissue (it was attempted twice, settled with a single lumen hickman port) and she also had a peripheral wrist 20 g. She was gettig TPN through the hickman and Vanco and zosyn through the PIV. Well now K+ is low, so I've got an order for 2 bags of potassium (no lidocaine or anything else). Ran that with saline in the PIV and blew the vein (shocking). Attempted to get another PIV and blew the vein ? So I recruited help from the US machine and some seasoned nurses who also informed me that TPN has potassium in it so I can run the potassium into the hickman port and run the TPN at the Y-site. I was ALSO taught that TPN should have a dedicated line but I was desparate and it worked well. We change out all the tubing and brand new tpn every 24 hours.

You're going to have to go by your facility policy here.

There are several things that are compatible with TPN. As was stated earlier in the thread, the policy at most facilities is to run only TPN and lipids through the same lumen. At my casual job (adult hospital), we keep that lumen dedicated to TPN and TPN only; even if the TPN is cycled you don't run anything but TPN through that lumen.

Not running other medications/fluids with TPN is a very very common policy/practice, but it is not the universal truth.

In my full time job (pediatrics) we often run other things through the line with TPN. This is because multi lumen central lines are less common in peds. If the med is compatible with the TPN then great, we long line it all together. If they aren't compatible, we flush and pause the TPN, run the med, the flush and restart the TPN. Hearing that is probably giving most adult nurses an anxiety attack, but it is a generally accepted practice.

I've also had TPN infusing in an adult home health patient who only had a single port, and he was started on a PCA that was compatible with the TPN, so it all went together through the same port (tpn, lipids, pain med -- I think it was dilaudid -- and NS for the pca).

Again though, you have to follow your policy. Any time I've run other meds with TPN, facility policy has allowed it (and the providers have been on board with it as well).

Something to keep in mind, though, is that compatibility can be concentration dependent and just because you can mix 20meq kcl into the bag of TPN does not necessarily mean that you can long line k riders into the y port on TPN (I actually think you can do that, but compatibility at one more dilute concentration does not confer compatibility at a stronger concentration).