TPN thru a peripheral line?

[ripcurl1]

I always thought that anything containing D10 or higher needer to be infused through some type of central venous line. I also thought that TPN must be administered by iteself. I recently started working for an institution who infuses TPN through a peripheral IV (NOT A PICC line) and will also combine meds and IVF with the TPN line. Does this sound right? Does anyone else do this at their hospital?

[Kyrshamarks, BSN, RN]

You can run TPN thru a peripheral line. You can run D25 for a short time thru the a PI but TPN for a periph is usually D12.5%. They run it all the time on kids and you can run lipids thru a periph also. Some meds are ok to go thru TPN. Check with your pharmacist on this. (this is after talking to my girlfriend who is a pharmacist in a hospital and makes TPN regularly)

[nrsang97, BSN, RN]

When I worked Med/Surg we did at times run TPN and lipids through a peripheral line. The TPN had to be made specifially for a peripheral line. This was also usually temporary until a PICC or Port were placed. If we did run through a peripheral line along with being specially made for a peripheral IV we had to use a 20g needle or larger. Also nothing is compatible so if IVF and IVPB and IVP meds we had to start a second line. You have to really watch that site since it is so easy for it to infiltrate since TPN is harsh to veins.

[AmyB]

No! TPN must be run through a central line! Also, the only thing we can run with it is the lipids (below the filter).

No need to even think of other meds to run with it, since most central lines have more than one port.

This is what was drilled into our heads in school. I guess I'd never given it much thought since then as it was very clear what we were to do...

[LoraLou]

our policy is TPN through a central line only, the only thing we are able to run with TPN is insulin, and there PPN (peripheral parenterl nutrition) that is prepared to run through a peripheral line.

[BittyBabyGrower, MSN, RN]

We run TPN thru peripherals all the time.....nothing higher than 12.5 though. There are many meds that are compatible with TPN....sometimes we have no choice in the NICU. Sure, I'd love to have a central line on all my kids, but it just doesn't happen. Also, we only use single lumen Broviacs in the kids where I work. We piggyback dopamine, insulin, antibiotics, narcotics, steroids, and lots of other things with it. Your pharmacy should have a compatibility list.

[Windmutt]

There is a tremendous amount of misinformation on this string.

1. Anything less than D10 and 5%AA can be run in a peripheral line.

2. Lipids are commonly mixed into a TPN bag and run together.

3. Drugs such as insulin are routinely shot into TPN bags. Check with pharmacy for compatibilities.

Please limit the hysteria if you don't know what you are talking about!

[CCL RN, RN]

There is a tremendous amount of misinformation on this string.

1. Anything less than D10 and 5%AA can be run in a peripheral line.

2. Lipids are commonly mixed into a TPN bag and run together.

3. Drugs such as insulin are routinely shot into TPN bags. Check with pharmacy for compatibilities.

Please limit the hysteria if you don't know what you are talking about!

This thread is 4 years old-but here ya go.. I missed the "hysteria". Sounds like everyone in this old thread knew what they were talking about, since they were quoting their own hospital policy.

1. That was covered by posters, specifically.

2. I haven't seen lipids mixed with tpn in well over 6 yrs. Most people only need lipids 3 times a week anyway. But again, most people already mentioned that lipids could run with tpn. So again, already covered.

3. Many people mentioned insulin being added to insulin bags. You added nothing new here...

So when criticizing people for hysteria, especially people from 4 years back, please try to add something new to the conversation.

[JEWELID]

tpn can be peripherally administered as long as the concentration is for a peripheral site. at my institution the bags look differed. central line bags are shaped differently than the peripheral line doses.

[AgentBeast, MSN, RN]

[divaRN*]

At my hospital we only give TPN through a dedicated TPN port of a central line. This means medication or IVF NEVER go through this line. Also, we do not draw blood off a TPN port. NS flushes ONLY. IF a TPN port has been accidently used for something other than TPN the port can no longer be used for TPN and the line has to be changed.

[wanderlust99]

PPN..not TPN,yes many times. It confused me at first too.

[blondy2061h, MSN, RN]

At my hospital we only give TPN through a dedicated TPN port of a central line. This means medication or IVF NEVER go through this line. Also, we do not draw blood off a TPN port. NS flushes ONLY. IF a TPN port has been accidently used for something other than TPN the port can no longer be used for TPN and the line has to be changed.

I'm not denying that this is your hospital's policy, but I'd love to know what evidence they based this policy off of. It seems ridiculous. In almost any critical care setting leaving a lumen just for TPN isn't realistic.