TPN Tubing Change

Gompers, BSN, RN · Mar 22, 2006

Our lipids get new bags and tubing every 24 hours.

All our other IV fluids (hyperal, dextrose solutions, narcotic and vasoactive drips) get new bags or syringes daily, but the actual tubing is changed ever 96 hours. If we have stock bags running that pharmacy hasn't "messed with" (like 0.9%NS with 2 units heparin/ml) then the bag itself can also run for 96 hours without being changed.

If there is a major change in the hyperal formula we will change the tubing even if it hasn't been 96 hours.

NicuNightRN · Mar 22, 2006

Our NICU does the same thing, Gompers.

hllybenn · Mar 22, 2006

Everything is 24 hours in our ICN- bags as well as tubing.

Finallyat40 · Mar 22, 2006

for TPN and lipids....Tubing can be used for up to 72 hours if there is only clear fluid running (i.e. 1/4 NS), but the actual fluid is 24 hours.

Jamie

thumperRN · Mar 23, 2006

Ours is changed every 24 hours at 1800. Pharmacy makes the mix and sends it with the tubing already primed and ready. Our lipids are never mixed, they come in a separate glass bottle, and we use regular primary tubing for that - it is simply hooked in to the most distal port on the TPN tubing. The TPN and lipids are run on separate pumps.

dawngloves, BSN, RN · Mar 23, 2006

Our tubing is q 72 h unless the mix has changed, then with the changed TPN.QD for lipids.

kmande · Aug 9, 2006

Majority of facilities have a policy of changing TPN/lipid tubing Q 24 hrs. Some even go as far as TPN tubing change Q 24 and Lipid tubing change Q 12. Due to the high dextrose concentration there is a great risk for bacteria to grow therefore the frwquent change. Most NICUs also spike their IV tubing using a 2 person sterile technique.

You can go to the CDC website and see there recommendations.

mawjood · Aug 10, 2006

TPN and lipid seperated and every thing changed every 24 h....

RNjbpltp · Aug 15, 2006

On our unit, both TPN bag and tubing is changed every 24 hours, same with the Lipids and lipid tubing; this is related to infection control. Also, they are NEVER mixed, as the TPN requires a filter and you cannot filter lipids. (this has been true on all four units/hospitals I have worked. Hope this helps.

TiffyRN, BSN, PhD · Aug 15, 2006

Also, they are NEVER mixed, as the TPN requires a filter and you cannot filter lipids.

I'm not sure why TPN and lipids are always separate but I'm pretty sure it's not because lipids can't be filtered. TPN and lipids are routinely mixed in the same bag in the adult world. There is a special filter that is used just for the TPN mixture (sometimes called 3 in 1 mixture for amino acids, dextrose and lipids).

I thought they were separate to make it easier to give IV meds because so many more meds are compatible with the amino acid/dextrose mixture and aren't compatible with the lipids. Some cancer patients that only have a single lumen PICC get their lipids bolused over 4hrs so other IV meds can be given in the same line as their TPN the rest of the day.

Gompers, BSN, RN · Aug 15, 2006

I'm not sure why TPN and lipids are always separate but I'm pretty sure it's not because lipids can't be filtered. TPN and lipids are routinely mixed in the same bag in the adult world. There is a special filter that is used just for the TPN mixture (sometimes called 3 in 1 mixture for amino acids, dextrose and lipids).
I thought they were separate to make it easier to give IV meds because so many more meds are compatible with the amino acid/dextrose mixture and aren't compatible with the lipids. Some cancer patients that only have a single lumen PICC get their lipids bolused over 4hrs so other IV meds can be given in the same line as their TPN the rest of the day.

Another reason they're separate in the NICU is because babies can only get so much lipids per day or their triglycerides will be all over the place. However, most of us use the hyperal as the maintenance fluids for the baby, and if fluid volume needs change, this is the IV that we increase or cut back on. If the lipids were mixed in, we'd be screwing up how much lipids the baby gets per day by changing the rate around.

The only time I've seen them mixed together was in home care. The babies who go home with Broviacs and TPN have these IV bags and tubing that have NO AIR in them, so either there is no filter for bubbles or if there is a filter, it's okay for lipids, I forget because it's been a couple of years since I've worked with one of these set-ups. The bag is kind of cool - it is a huge flat IV bag that has hyperal on one side and lipids on the other, separated by a plastic clip. Each day, the mom takes a new bag out of the fridge and pulls the plastic clip off, and then the hyperal and lipids mix together. She primes new tubing and runs it through a small IV pump, the puts the pump and bag into a small backpack, with just the tubing running to the baby. It's smaller than the apnea monitors, even!