Tpn

[KatieRN04]

Ok, so question about TPN. I recently started at a new hospital in a new state, and I am always shocked out how things are so "slap happy" at this new hospital, but this hospital is the biggest one in the city, so they can do things thier own way, but anyways. I am always taught during nursing school, nearly 3 years out, and at a hospital I used to work at, when initiating TPN (with or without lipids), you needed a central line (TLC or PICC), and that thier had to be a "virgin port", or a port never used for any med, electrolyes, abx, absolutely nothing. And if you had a central line before TPN started, that it had to be changed over guide wire, or a new site, or else a new PICC. So at the new hospital, I was told that I was crazy when I asked this question when I got new orders to start TPN. So the question is, what is the policy regarding TPN at your hospitals across the USA? We started new lines to decrease central line infections since TPN is so "sugary" and a perfect environment for infection.

[Kelky]

I had TPN while ill with hyperemesis, through peripheral lines. They didn't last long though.

[Pedi-ER-RN, RN]

It's been awhile since I've given TPN (since I work ER), but I've never worked anywhere that would allow TPN to be infused in anything but a central line. Some places administer PPN (peripheral parenteral nutrition) via peripheral IV. Most places have policies governing the max % of dextrose that can be infused peripherally, check the policy and procedure book of your institution.

Never heard of having to have a new line, have infused TPN to pts who had lines for years!!

[jmgrn65, RN]

We don't insert a new line but do infuse via a PICC or Central line. Also thier is PPN for peripheral ivs.

[Blee O'Myacin, BSN, RN]

have to be a fresh line. On our unit, we are even allowed through policy to run certains meds Y-ed into the TPN line (cippro and bactrim are two I can think of off the top of my head - and morphine 1mg/ml)

Even though TPN is the perfect medium for growing nasties, starting a central line everytime also is a huge infection liability. Especially when you have a population of patients that no longer have peripheral access due to lengthy illness. (I work heme/onc critical care)

I've found that hospital policy adapts more to real world circumstances than what I was taught in nursing school. They always seemed to present the "perfect NCLEX world" where no patient ever gets out of bed, drags their full depends across the floor and misses the commode, but manages to get their tubing completely covered in feces... (I didn't get presented with that situation until I was in my second week of orientation and my preceptor kindly chuckled at my horror and welcomed me to the club...)

Hope this clears up some of your questions. While we don't handle TPN like blasting oil, it doesn't mean that we aren't aware of the inherent risks of IV nutrition. Sometimes the need outweighs the risk.

Blee

[jonear2, RN]

I graduated in December 2005 and I dont remember learning that the central line must be "fresh" (not to say that they didnt teach that he he), but no, at my facility we give TPN all the time through previously used central lines. Also asa stated in one of the previous posts, we also can give certain meds through the y site as long as they are compatible. I have also given PPN but only through like an 18g and not for very long. I would hate to have that stuff infiltrate the vein.

[floatRN]

I remember learning in nursing school that TPN has to go through a line that was never used for anything else. However, I have never seen that done where I work. In most cases it would not be practical. We give PPN through peripherals and TPN through a central line only.

[GatorRN]

Yes, TPN can only be infused into a central line. PPN can be infused into a peripheral line.

Every facility has their own protocol regarding TPN/PPN. I would look up the policy and procedures for your particular facility. In the perfect world, yes, TPN should be infused into a line that's not been used for anything else. However, that's not always the case.

Starting a new central line just to infuse TPN isn't practical either. The risk of infection from starting a new line would be greater than infusing TPN into a line that's been used before. Always flush the line well before starting TPN through it. We usually leave the distal port for TPN infusion only, if at all possible. We never ever y-site any other meds along with TPN.

[Gompers, BSN, RN]

I've never heard of this, in school or in practice. I work in the NICU with some of the most immunosupressed patients in the hospital, and we've never even touched on this subject.

There are limits on the amount of dextrose and protein that can be given through peripheral IVs, but you can certainly give hyperal through them. We also have a list of what medications can be plugged into the Y-port and infused with the TPN - we do everything from morphine/fentanyl and dopamine/dobutamine drips, to antibiotics and steroids, you name it.

The only thing we're sure to do is that we flush the line well with saline first before changing IV solutions, especially if we're going to be piggybacking lipids into the line or giving an incompatible medication.